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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Motor competence &#40;MC&#41; is indispensable for many functional and purposeful tasks in daily life&#44; sports&#44; and recreational activities&#46; Alongside strength and power&#44; MC is reflective of the cooperative function of the central and peripheral nervous systems and the musculoskeletal system&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a> Recent research has demonstrated strong evidence of associations between MC and cardiorespiratory fitness&#44;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">2&#44;3</span></a> body weight status&#44;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">2&#44;3</span></a> and physical activity&#44;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">3&#44;4</span></a> suggesting that MC may have an important impact on children&#39;s health&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">3&#44;5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Association between MC and body weight status is observed even in early childhood &#40;5 years&#41;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">6&#44;7</span></a> and continues through early adulthood&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a> Specifically&#44; Lopes et al&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a> and D&#8217;Hondt et al&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">7</span></a> analyzed cross-sectional associations between gross MC and weight status in children ages 6&#8211;14 and 5&#8211;12 years old&#44; respectively&#44; and noted that children with higher MC scores already demonstrated lower BMI at 5&#8211;6 years old&#46; In addition&#44; the inverse strength of associations between MC and BMI became larger with increasing age&#46; Fransen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a> also observed the same phenomenon with two-year longitudinal data&#46; Importantly&#44; associations between MC and BMI were not mediated by physical activity in this study&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a> Data from the previously mentioned studies and others provide indirect support for a heuristic model that proposes MC and body weight status will demonstrate reciprocal relationships across childhood&#44; with increasing strengths of association across childhood&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">5&#44;11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The model also proposes that MC and aspects of health-related physical fitness &#40;<span class="elsevierStyleItalic">i&#46;e&#46;</span>&#44; cardiorespiratory endurance&#44; muscular strength&#47;endurance&#41; will demonstrate the same reciprocal relationships across childhood&#46; Recent review articles generally support these views&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">2&#44;3&#44;5</span></a> Cardiorespiratory fitness is consistently correlated with MC in children and adolescents&#44; with recent a systematic review noting that 12 out of 12 studies demonstrated positive associations between MC and cardiorespiratory fitness&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">2</span></a> The development of gross MC promotes independent upright posture and locomotion in early childhood&#44; which is suggested to influence the early improvement of cardiorespiratory fitness in children<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleItalic">via</span> the repetitive nature of movement exploration &#40;<span class="elsevierStyleItalic">e&#46;g</span>&#46;&#44; crawling&#44; walking&#41;&#46; Hands<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">12</span></a> and Cairney and Veldhuizen<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">13</span></a> observed that motorically delayed children had lower cardiorespiratory fitness performance compared to peers with higher gross motor coordination&#44; with the difference remaining after two to five years of follow-up&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">While the aforementioned cross-sectional and longitudinal data provide strong evidence for consistent inverse associations between MC and weight status and positive associations between MC and cardiorespiratory fitness&#44; a causal pathway between these variables is still not clear&#46; Recently&#44; Robinson et al&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a> compiled the literature that investigated the potential impact of MC on health-related factors&#46; In summary&#44; the authors noted that cardiorespiratory fitness &#40;positively&#41; and fatness &#40;negatively&#41; were longitudinally associated with MC during childhood&#46; However&#44; the possible reciprocal association between MC and fitness and fatness has not been fully addressed&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">It is important to test whether relationships between MC&#44; cardiorespiratory fitness&#44; and fatness are reciprocal to provide knowledge to more successful interventions aiming to increase MC and fitness levels and decrease fatness during childhood and adolescence&#46; This evidence can also support policy makers designing policies for this population&#46; To provide a more comprehensive understanding of the long-term relationships between the health-related components of MC&#44; cardiorespiratory fitness&#44; and fatness&#44; the authors analyzed the longitudinal associations &#40;seven-year span from childhood into beginning adolescence&#41; among fitness &#40;VO<span class="elsevierStyleInf">2peak</span>&#41;&#44; fatness &#40;sum of four skinfolds&#41;&#44; and MC levels&#44; and the potential reciprocal nature of these associations&#46; More specifically&#44; the strengths of the relationships among these variables were evaluated over time&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">This study was based on longitudinal analysis of data from the Copenhagen School Child Intervention Study &#40;CoSCIS&#41;&#44; which began in 2001&#46; Children attending preschool class in two communities in the area of Copenhagen &#40;46 preschool classes in 18 schools&#41; were recruited to participate in the study&#46; CoSCIS is a controlled longitudinal intervention study that took place in 18 public schools &#40;ten interventions and eight controls&#41; in two suburbs of Copenhagen&#46; The local Authority of Ballerup had decided to upgrade the physical activity opportunities for their youngest schoolchildren and contacted the research group to quantify and measure the effect of such an intervention&#46; The intervention was hereafter planned in cooperation between the local authority and the researchers&#46; All children from 46 preschool classes &#40;age 6&#8211;7 years&#41; in the schools in the two local authorities were invited to participate in the study&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> The study was approved by the ethical committee&#44; University of Copenhagen &#40;reference KA00011gm&#41;&#46; Written informed consent was obtained from the parents&#47;guardians of 706 children &#40;69&#37; of the population&#41;&#44; and 696 actually participated in the study at baseline&#46; The intervention lasted three years and no key variables examined in this study were affected by the intervention&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> Children were followed up again in 2008 at 13 years&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Because the complete methodology has been previously published&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> the methodology here presents only those variables of interest&#46; Bicipital&#44; tricipital&#44; subscapular&#44; and suprailiac skinfolds were measured on the self-reported nondominant side of the body by the same two skilled researchers with a Harpender skinfold caliper &#40;Harpender&#44; West Sussex&#44; United Kingdom&#41;&#44; and fatness was computed as the sum of the four skinfolds &#40;S4SF&#41;&#46; Cardiorespiratory fitness &#40;VO<span class="elsevierStyleInf">2peak</span>&#41; was assessed using a continuous running protocol on a treadmill until exhaustion&#46; VO<span class="elsevierStyleInf">2peak</span> was measured directly on an AMIS 2001 Cardiopulmonary Function Test System &#40;Innovision&#44; Odense&#44; Denmark&#41; at 6 and 9 years-of-age&#44; and using a COSMED K4b<span class="elsevierStyleSup">2</span> portable metabolic system &#40;COSMED&#44; Rome&#44; Italy&#41; at 13 years-of-age&#46; Both systems provide valid measures of VO<span class="elsevierStyleInf">2</span> when validated against the Douglas bag method&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">15&#8211;17</span></a> From 9 to 13 years of age&#44; the pubertal status was reported using the Tanner scale&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">18</span></a> with pictures of breasts for girls and genital development for boys&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">MC was assessed using the K&#246;rperkoordinationstest f&#252;r Kinder &#40;KTK&#41;&#44; which is a standardized normative German test battery&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a> The KTK has high test-retest reliability &#40;0&#46;90 to 0&#46;97&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a> It consists of four independent tests&#58; &#40;1&#41; walking backwards on balance beams of decreasing width&#58; 6&#46;0&#44; 4&#46;5&#44; and 3&#46;0<span class="elsevierStyleHsp" style=""></span>cm &#40;KTK<span class="elsevierStyleInf">BEAM</span>&#41;&#44; &#40;2&#41; moving sideways on wooden boards for 20<span class="elsevierStyleHsp" style=""></span>s &#40;KTK<span class="elsevierStyleInf">BOARD</span>&#41;&#44; &#40;3&#41; one-legged hopping over a foam obstacle with increasing height in consecutive steps of 5<span class="elsevierStyleHsp" style=""></span>cm &#40;KTK<span class="elsevierStyleInf">HOP</span>&#41;&#44; and &#40;4&#41; two-legged jumping from side to side for 15<span class="elsevierStyleHsp" style=""></span>s &#40;KTK<span class="elsevierStyleInf">JUMP</span>&#41;&#46; The KTK battery has been used in numerous studies to evaluate MC performance levels in normally developing children and adolescents up to 15 years-of-age&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">20&#44;21</span></a> The raw performance score on each item was summed and standardized in <span class="elsevierStyleItalic">Z</span>-scores &#40;KTK <span class="elsevierStyleItalic">Z</span>-score&#41; to evaluate the longitudinal association between the S4SF&#44; VO<span class="elsevierStyleInf">2peak</span>&#44; and MC&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In all analyses&#44; STATA version 13&#46;0 was used &#40;StataCorp&#44; College Station&#44; TX&#44; USA&#41;&#46; We performed multilevel linear regressions to evaluate the reciprocal longitudinal association between VO<span class="elsevierStyleInf">2peak</span>&#44; S4SF&#44; and MC&#44; and how this possible reciprocal longitudinal association would develop over time&#46; Therefore&#44; it was analyzed whether VO<span class="elsevierStyleInf">2peak</span> and S4SF &#40;exposure variables&#41; influence MC &#40;outcome&#41; development&#44; and also whether MC &#40;exposure variable&#41; impacts the development of VO<span class="elsevierStyleInf">2peak</span> and S4SF &#40;outcomes&#41;&#46; Note that independent multilevel linear regressions were performed to evaluate the relationships between MC and VO<span class="elsevierStyleInf">2peak</span>&#44; and between MC and S4SF&#46; Therefore&#44; VO<span class="elsevierStyleInf">2peak</span> and S4SF were not in the same regression models&#46; Standardized <span class="elsevierStyleItalic">&#946;</span> coefficients are presented for each testing time &#40;results in figures&#41; and the overall longitudinal relationship over seven years of follow-up &#40;results in text&#41;&#44; both provided by the same multilevel models&#46; Standardized <span class="elsevierStyleItalic">&#946;</span> coefficients are presented to help readers to compare the strength between coefficients&#46; This approach has been used previously&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">22</span></a> Children with missing information in one of the three measuring points were included in the analyses&#46; The hierarchical data structure was taken into account with students nested in school classes&#44; and school classes nested in schools &#40;random effects&#41;&#46; The regressions were adjusted for group &#40;intervention&#59; control&#41;&#44; and pubertal status &#40;prepubertal&#44; initial puberty&#44; and puberty&#41;&#46; All the analyses were stratified by sex &#40;boys and girls&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In all multilevel regression models&#44; the variance related to the clusters &#40;school and classes within school&#41; and the intraclass correlation coefficient &#40;ICC&#41; were calculated for each model to interpret the variation between school classes&#44; classes&#44; and individuals&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">23&#44;24</span></a> In all regression models&#44; the majority of the variation &#40;ICC&#41; was based on the individual level &#40;the conjugated ICCs from school and classes were always below 5&#37;&#41;&#46; All regression models were tested for linearity between dependent and independent variables&#59; normality of the regression equation residuals&#59; and the variance equality of the equation residuals&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">The majority of the boys at 9 years of age were in the initial stages of genitalia development &#40;95&#46;4&#37; in stage 1 and 4&#46;6&#37; in stage 2&#41;&#46; At 13 years of age&#44; most of the boys characterized themselves in stage 3 in genitalia development &#40;45&#46;7&#37;&#41;&#44; followed by stage 4 &#40;40&#46;3&#37;&#41;&#44; stages 2 and 5 &#40;6&#46;3&#37; each&#41;&#44; and stage 1 &#40;1&#46;4&#37;&#41;&#46; At 9 years of age&#44; 54&#46;7&#37; of the girls recognized themselves as being in stage 1 regarding their breast development&#44; while 40&#46;4&#37; reported being in stage 2 and 4&#46;9&#37; reported being in stage 3&#46; At 13 years of age&#44; most of the girls characterized themselves as being in stage 4 &#40;55&#46;3&#37;&#41;&#44; 23&#46;3&#37; reported being in stage 3&#44; 15&#46;2&#37; reported being in stage 5&#44; 5&#46;7&#37; reported being in stage 2&#44; and 0&#46;5&#37; reported being in stage 1&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> presents the physical and motor characteristics of the participants in each age period of monitoring&#46; Differences were observed in VO<span class="elsevierStyleInf">2peak</span> and S4SF between boys and girls in all age ranges&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Reciprocal longitudinal relationship between MC and S4SF</span><p id="par0065" class="elsevierStylePara elsevierViewall">Results indicated MC and S4SF demonstrated a reciprocal influence on each other across time for both boys and girls&#46; For both boys and girls&#44; S4SF had a stronger association in the development of MC &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleInf">boys</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;45 <span class="elsevierStyleItalic">Z</span>-scores&#44; 95&#37; CI&#58; &#8722;0&#46;52 to &#8722;0&#46;38&#59; <span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleInf">girls</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;35 <span class="elsevierStyleItalic">Z</span>-scores&#44; 95&#37; CI&#58; &#8722;0&#46;42 to &#8722;0&#46;28&#41;&#44; as opposed to MC influencing the development of S4SF &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleInf">boys</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;31 <span class="elsevierStyleItalic">Z</span>-scores&#44; 95&#37; CI&#58; &#8722;0&#46;36 to &#8722;0&#46;26&#59; <span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleInf">girls</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;26 <span class="elsevierStyleItalic">Z</span>-scores&#44; 95&#37; CI&#58; &#8722;0&#46;31 to &#8722;0&#46;20&#41;&#46; The strength of the longitudinal association between MC and S4SF was also evaluated over time&#46; For boys&#44; the strength of the association between MC and S4SF increased across follow-up time points&#44; independent of the direction analyzed&#46; While for girls&#44; an increase in the strength of the association was observed from 6 to 9 years-of-age&#44; and maintenance of the strength of the association from 9 to 13 years-of-age&#44; independent of the direction analyzed &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Reciprocal longitudinal relationship between MC and VO<span class="elsevierStyleInf">2peak</span></span><p id="par0070" class="elsevierStylePara elsevierViewall">Independent of sex&#44; MC and VO<span class="elsevierStyleInf">2peak</span> also demonstrated reciprocal relationships across time&#46; Although for boys&#44; MC demonstrated a stronger influence on VO<span class="elsevierStyleInf">2peak</span> &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleInf">boys</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;34 <span class="elsevierStyleItalic">Z</span>-scores&#44; 95&#37; CI&#58; 0&#46;27&#8211;0&#46;40&#41;&#44; as opposed to the influence of VO<span class="elsevierStyleInf">2peak</span> on the development of MC &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleInf">boys</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;24 <span class="elsevierStyleItalic">Z</span>-scores&#44; 95&#37; CI&#58; 0&#46;18&#8211;0&#46;30&#41;&#46; While for girls&#44; results did not demonstrate a marked differential effect of one variable on the development of the other variable across time &#40;VO<span class="elsevierStyleInf">2peak</span><span class="elsevierStyleHsp" style=""></span>&#8594;<span class="elsevierStyleHsp" style=""></span>MC&#59; <span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleInf">girls</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;25 <span class="elsevierStyleItalic">Z</span>-scores&#44; 95&#37; CI&#58; 0&#46;18&#8211;0&#46;32&#41; &#40;MC<span class="elsevierStyleHsp" style=""></span>&#8594;<span class="elsevierStyleHsp" style=""></span>VO<span class="elsevierStyleInf">2peak</span>&#59; <span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleInf">girls</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;27 <span class="elsevierStyleItalic">Z</span>-scores&#44; 95&#37; CI&#58; 0&#46;20&#8211;0&#46;33&#41;&#46; Evaluating the pattern of associations between MC and VO<span class="elsevierStyleInf">2peak</span> across the time points in boys&#44; independent of the direction analyzed&#44; it was possible to observe an increase in the strength of the association from 6 to 9 years-of-age and a subsequent maintenance at 13 years-of-age&#46; While for girls&#44; the strength of the association that MC had on the development of VO<span class="elsevierStyleInf">2peak</span> was relatively stable during the follow-up period &#40;0&#46;24<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#46;30&#41;&#46; On the other hand&#44; the impact of VO<span class="elsevierStyleInf">2peak</span> on MC increased from 6 to 9 years-of-age and stabilized from nine to 13 years-of-age &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">Overall&#44; this study observed a reciprocal relationship between children&#39;s MC with S4SF and VO<span class="elsevierStyleInf">2peak</span> across the seven-year follow-up &#40;6&#8211;13 years of age&#41;&#46; Children with lower MC performance at baseline had higher risk of having higher S4SF and lower VO<span class="elsevierStyleInf">2peak</span> during childhood&#46; Alternatively&#44; higher S4SF or lower levels of VO<span class="elsevierStyleInf">2peak</span> at baseline were associated with lower MC development across time&#46; Except for the stable longitudinal relationship between MC and VO<span class="elsevierStyleInf">2peak</span> for girls&#44; the strength of the association between MC and S4SF and VO<span class="elsevierStyleInf">2peak</span> increased from 6 to 9 years of age and then was fairly stable from 9 to 13 years of age in both boys and girls&#44; independent of the direction analyzed &#40;MC<span class="elsevierStyleHsp" style=""></span>&#8594;<span class="elsevierStyleHsp" style=""></span>S4SF&#44; S4SF<span class="elsevierStyleHsp" style=""></span>&#8594;<span class="elsevierStyleHsp" style=""></span>MC&#59; MC<span class="elsevierStyleHsp" style=""></span>&#8594;<span class="elsevierStyleHsp" style=""></span>VO<span class="elsevierStyleInf">2peak</span>&#44; VO<span class="elsevierStyleInf">2peak</span><span class="elsevierStyleHsp" style=""></span>&#8594;<span class="elsevierStyleHsp" style=""></span>MC&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">To the best of our knowledge&#44; this is the first long-term follow-up study &#40;seven years&#41; to evaluate the potential reciprocal relationship between MC and S4SF that also evaluated the strength of the association over time&#46; Robinson et al&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a> also noted the lack of literature addressing these important developmental findings and thus&#44; these data add to the existing literature in this area&#46; As most previous studies addressing these variables used BMI as their assessment of obesity status&#44; the use of skinfolds in the present study provided a more valid measure of body fat across childhood and into adolescence&#44; when BMI becomes a less valid measure of obesity&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a> The current data expand on previous four-year longitudinal data published by Lopes et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a> who also observed that children with higher MC at baseline demonstrated lower body fatness across time&#44; as measured by the sum of skinfolds&#46; Overall&#44; the mutual relationship between MC and body fat across childhood suggests the need to consistently address them&#44; <span class="elsevierStyleItalic">via</span> intervention on both factors to potentialize the effects of the intervention&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The present study partially supports the heuristic model proposed by Stodden et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a> which hypothesizes that MC and body weight status will demonstrate reciprocal relationships across childhood with increasing strengths of associations across childhood&#46; It is logical that heavier children face problems to be active and develop their MC&#44; as compared to their normal weight peers&#46; Alternatively&#44; children who demonstrate lower MC demonstrate less success and enjoyment in many developmentally appropriate activities &#40;<span class="elsevierStyleItalic">e&#46;g&#46;</span>&#44; sports and games&#41;&#59; thus&#44; they are less likely to continue to participate in activities that inherently demand various forms of MC&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a> This further hinders MC development and physical activity participation&#44; and promotes negative developmental trajectories of MC&#44; weight status&#44; and fitness&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">26</span></a> In fact&#44; it was possible to observe reciprocal associations between S4SF and MC that became stronger across age &#40;boys&#58; increase during the whole period of monitoring&#41; or remained stable &#40;girls&#58; increase until 9 years of age with subsequent stabilization&#41;&#44; which could mean that successful intervention with a focus on both unhealthy weight gain &#40;<span class="elsevierStyleItalic">i&#46;e&#46;</span>&#44; nutrition and physical activity&#41; and low MC in early childhood might have greater sustained impact across childhood&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">26</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Of course&#44; children&#39;s cardiovascular endurance is not independent from either obesity or MC&#46; The demonstrated reciprocal relationship between MC and cardiovascular endurance partially demonstrates this affect&#46; Few studies have analyzed the association between MC and fitness level longitudinally&#44;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">2&#44;12&#44;27</span></a> but to the best of our knowledge&#44; none have analyzed if MC and VO<span class="elsevierStyleInf">2peak</span> mutually influence the development of each other during childhood&#46; In particular&#44; the majority of studies have only looked at the influence of MC on physical fitness&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a> It has been shown that lower MC negatively influences cardiorespiratory fitness development&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">10&#44;12&#44;28</span></a> In a six-year follow-up study &#40;10 year-old children at baseline&#41;&#44; Barnett et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a> observed that MC at baseline predicted the fitness level in Australian children&#46; Complementarily&#44; perceived sports competence mediated this relationship&#46; It was interesting to note that the present data indicated MC has a larger suggested impact on VO<span class="elsevierStyleInf">2peak</span> development than the reverse causality from 6 to 9 years-of-age&#46; However&#44; from ages of 9 to 13 or for girls&#44; the regression models did not demonstrate stronger relationships in either direction&#46; According to these results&#44; the capability to successfully participate in many different activities that inherently require adequate levels of MC probably generates more opportunities to be physically active&#44; thus leading to higher cardiorespiratory fitness and decreased body fatness&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a> Subsequently&#44; higher cardiorespiratory fitness would allow for longer participation&#44; and a higher chance to develop better MC&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In particular&#44; the different pattern of the relationships between MC&#44; S4SF&#44; and VO<span class="elsevierStyleInf">2peak</span> for boys and girls might be partially explained by their pubertal status&#46; Because MC&#44; S4SF&#44; and VO<span class="elsevierStyleInf">2peak</span> did not differ for boys and girls due to the effects of the initial intervention that was conducted from the ages of 6 to 9 years<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> and because girls reach higher pubertal status sooner than boys&#44; it is possible that the physical development was being influenced by their maturational status&#46; In addition&#44; the fact that girls decrease their participation in physical activities sooner than boys might also influence the pattern of the relationships between MC&#44; S4SF&#44; and VO<span class="elsevierStyleInf">2peak</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">This study had some limitations that have to be considered in the interpretation of the results&#46; This longitudinal study was part of an intervention project and some results could be influenced by the intervention&#59; however&#44; this study presented a follow-up of four years after the intervention ended and the analyses were adjusted for group &#40;intervention&#44; control&#41;&#46; In addition&#44; the intervention did not influence MC development&#44; VO<span class="elsevierStyleInf">2peak</span>&#44; or S4SF&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> Longitudinal studies provide valuable inferences about causal mechanisms&#59; however&#44; evidence for causality would be further strengthened with experimental evidence&#46; It would be valuable to assess pubertal status by a more precise measure&#46; Some of the differences in the associations between boys and girls might be explained by differences in pubertal status&#46; Another limitation is the fact that the nutrition&#47;diet and physical activity level of the participants were not accounted for in the study&#44; which may have influenced the association between variables&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The development of MC&#44; S4SF&#44; and VO<span class="elsevierStyleInf">2peak</span> trajectories across childhood and into adolescence &#40;6&#8211;13 years of age&#41; seems to be the result of reciprocal mechanisms&#46; It seems logical that interventions should address MC&#44; cardiorespiratory fitness&#44; and other factors associated with body fatness in early childhood&#44; as early intervention effects are likely to be enhanced because of the reciprocal and potentially synergistic associations between these three variables across time&#46; As noted&#44; by the increasing strength of associations across both time points or in at least one longitudinal time point&#44; promoting MC&#44; fitness&#44; and a healthy weight status in early childhood can promote positive developmental trajectories of these variables across childhood and into adolescence&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0110" class="elsevierStylePara elsevierViewall">This work was supported by a CAPES Scholarship&#44; number&#58; 1361&#47;13-9&#44; The Danish Heart Foundation&#44; and TrygFonden&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicts of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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              "identificador" => "sec0020"
              "titulo" => "Reciprocal longitudinal relationship between MC and S4SF"
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              "titulo" => "Reciprocal longitudinal relationship between MC and VO"
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    "fechaRecibido" => "2017-10-20"
    "fechaAceptado" => "2018-02-26"
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          "palabras" => array:6 [
            0 => "Motor development"
            1 => "Longitudinal studies"
            2 => "Health behavior"
            3 => "Risk factors"
            4 => "Obesity"
            5 => "Physical fitness"
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      ]
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          "palabras" => array:6 [
            0 => "Desenvolvimento motor"
            1 => "Estudos longitudinais"
            2 => "Comportamento saud&#225;vel"
            3 => "Fatores de risco"
            4 => "Obesidade"
            5 => "Aptid&#227;o f&#237;sica"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To examine longitudinal &#40;seven years&#41; relationships among cardiorespiratory fitness &#40;VO<span class="elsevierStyleInf">2peak</span>&#41;&#44; body fatness&#44; and motor competence&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Data were collected as part of the Copenhagen School Child Intervention Study &#40;CoSCIS&#41;&#46; Body fatness was assessed by the sum of four skinfolds&#46; VO<span class="elsevierStyleInf">2peak</span> was measured directly in a continuous running protocol&#46; Motor competence was assessed using the K&#246;rperkoordinationtest f&#252;r Kinder&#46; This study used multilevel linear mixed models to evaluate the reciprocal longitudinal association between body fatness&#44; VO<span class="elsevierStyleInf">2peak</span>&#44; and motor competence&#46; All regressions were stratified by sex and adjusted by intervention and pubertal status&#46; All variable coefficients were standardized&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A reciprocal relationship was observed between children&#39;s motor competence with body fatness and VO<span class="elsevierStyleInf">2peak</span> at the seven-year follow-up &#40;6&#8211;13 years of age&#41;&#46; Children with higher motor competence at baseline had a lower risk of having higher body fatness &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleInf">boys</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;45&#44; 95&#37; CI&#58; &#8722;0&#46;52 to &#8722;0&#46;38&#59; <span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleInf">girls</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;35&#44; 95&#37; CI&#58; &#8722;0&#46;42 to &#8722;0&#46;28&#41; and higher VO<span class="elsevierStyleInf">2peak</span> &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleInf">boys</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;34&#44; 95&#37; CI&#58; 0&#46;27&#8211;0&#46;40&#59; <span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleInf">girls</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;27&#44; 95&#37; CI&#58; 0&#46;20&#8211;0&#46;33&#41; during childhood&#46; Alternatively&#44; higher body fatness or lower levels of VO<span class="elsevierStyleInf">2peak</span> at baseline were associated with lower motor competence during childhood&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">These data suggest motor competence&#44; body fatness&#44; and VO<span class="elsevierStyleInf">2peak</span> demonstrate reciprocal relationships across childhood &#40;6&#8211;13 years of age&#41;&#46; Interventions addressing motor competence&#44; cardiorespiratory fitness&#44; and body fatness in early childhood are recommended&#44; as intervention effects are likely to be enhanced because of the mutual reciprocal associations between these three variables&#46;</p></span>"
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          1 => array:2 [
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            "titulo" => "Method"
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          2 => array:2 [
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Examinar as rela&#231;&#245;es longitudinais &#40;sete anos&#41; entre a aptid&#227;o cardiorrespirat&#243;ria &#40;VO<span class="elsevierStyleInf">2</span> pico&#41;&#44; gordura corporal e coordena&#231;&#227;o motora&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Os dados foram coletados como parte do <span class="elsevierStyleItalic">Copenhagen School Child Intervention Study &#40;CoSCIS&#41;</span>&#46; A gordura corporal foi avaliada pela soma de quatro dobras cut&#226;neas&#46; O VO<span class="elsevierStyleInf">2</span> pico foi medido diretamente em um protocolo de corrida cont&#237;nua&#46; A coordena&#231;&#227;o motora foi avaliada com o teste de coordena&#231;&#227;o corporal para crian&#231;as &#40;<span class="elsevierStyleItalic">K&#246;rperkoordination f&#252;r Kinder</span> &#8211; KTK&#41;&#46; Usamos modelos lineares mistos multin&#237;veis para avaliar a associa&#231;&#227;o longitudinal rec&#237;proca entre a gordura corporal&#44; o VO<span class="elsevierStyleInf">2</span> pico e a coordena&#231;&#227;o motora&#46; Todas as regress&#245;es foram estratificadas por sexo e ajustadas para interven&#231;&#227;o e estado puberal&#46; Todos os coeficientes das vari&#225;veis foram padronizados&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Observamos uma rela&#231;&#227;o rec&#237;proca entre a coordena&#231;&#227;o motora e a gordura corporal&#46; As crian&#231;as com maior coordena&#231;&#227;o motora no in&#237;cio do estudo apresentaram menor risco de ter maior n&#237;vel de gordura corporal &#40;&#946;<span class="elsevierStyleInf">meninos</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>-0&#44;45&#44; IC de 95&#37;&#58; -0&#44;52&#58; -0&#44;38&#59; &#946;<span class="elsevierStyleInf">meninas</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>-0&#44;35&#44; IC de 95&#37;&#58; -0&#44;42&#58; -0&#44;28&#41; e maior VO<span class="elsevierStyleInf">2</span> pico &#40;&#946;<span class="elsevierStyleInf">meninos</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;34&#44; IC de 95&#37;&#58; 0&#44;27&#58; 0&#44;40&#59; &#946;<span class="elsevierStyleInf">meninas</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;27&#44; IC de 95&#37;&#58; 0&#44;20&#58; 0&#44;33&#41;&#46; Por outro lado&#44; maior n&#237;vel de gordura corporal ou menores n&#237;veis de VO<span class="elsevierStyleInf">2</span> pico no in&#237;cio do estudo foram associados a menor coordena&#231;&#227;o motora durante a inf&#226;ncia&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Esses dados sugerem que a coordena&#231;&#227;o motora&#44; gordura corporal e VO<span class="elsevierStyleInf">2</span> pico demonstram rela&#231;&#245;es rec&#237;procas durante a inf&#226;ncia &#40;6-13 anos&#41;&#46; S&#227;o recomendadas interven&#231;&#245;es que abordem a coordena&#231;&#227;o motora&#44; a aptid&#227;o cardiorrespirat&#243;ria e a gordura corporal na primeira inf&#226;ncia&#44; pois os efeitos da interven&#231;&#227;o s&#227;o provavelmente maiores devido &#224;s associa&#231;&#245;es rec&#237;procas m&#250;tuas entre essas tr&#234;s vari&#225;veis&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Lima RA&#44; Bugge A&#44; Ersb&#248;ll AK&#44; Stodden DF&#44; Andersen LB&#46; The longitudinal relationship between motor competence and measures of fatness and fitness from childhood into adolescence&#46; J Pediatr &#40;Rio J&#41;&#46; 2019&#59;95&#58;482&#8211;8&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Parameter estimates of the slope for the association between S4SF and MC at 6&#44; 9&#44; and 13 years of age&#46; &#40;a&#41; Gray line&#58; S4SF &#40;exposure&#41; and MC &#40;outcome&#41;&#59; &#40;b&#41; black line&#58; MC &#40;exposure&#41; and S4SF &#40;outcome&#41;&#46; Adjusted for&#58; group &#40;intervention&#59; control&#41;&#44; and pubertal status &#40;prepubertal&#44; initial puberty and puberty&#41;&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">S4SF&#44; sum the four skinfolds&#59; MC&#44; motor competence&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Parameter estimates of the slope for the association between VO<span class="elsevierStyleInf">2peak</span> and MC at 6&#44; 9&#44; and 13 years of age&#46; &#40;a&#41; Gray line&#58; VO<span class="elsevierStyleInf">2peak</span> &#40;exposure&#41; and MC &#40;outcome&#41;&#59; &#40;b&#41; black line&#58; MC &#40;exposure&#41; and VO<span class="elsevierStyleInf">2peak</span> &#40;outcome&#41;&#46; Adjusted for&#58; group &#40;intervention&#59; control&#41;&#44; and pubertal status &#40;prepubertal&#44; initial puberty&#44; and puberty&#41;&#46; MC&#44; motor competence&#46;</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">KTK&#44; K&#246;rperkoordinationtest f&#252;r Kinder&#59; S4SF&#44; sum the four skinfolds&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">13 years&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">6 years&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">9 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">13 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">6 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">9 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">13 years&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">696&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">615&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">442&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">369&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">323&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">231&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">327&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">292&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">211&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">KTK score&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">119&#46;18 &#40;27&#46;66&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">195&#46;17 &#40;34&#46;64&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">249&#46;40 &#40;29&#46;41&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">VO<span class="elsevierStyleInf">2peak</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;mL<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">&#8722;1</span><span class="elsevierStyleHsp" style=""></span>min<span class="elsevierStyleSup">&#8722;1</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">46&#46;71 &#40;5&#46;97&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">S4SF<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
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        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Mean &#40;SD&#41; physical and motor characteristics of participants by age and sex&#46;</p>"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "The relationship between specific strength components of lower limbs and vertical jumping ability in school-aged children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; Katartzi"
                            1 => "E&#46; Gantiraga"
                            2 => "C&#46; Papadopoulos"
                            3 => "G&#46; Komsis"
                          ]
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Hum Mov Stud"
                        "fecha" => "2005"
                        "volumen" => "48"
                        "paginaInicial" => "227"
                        "paginaFinal" => "243"
                      ]
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              "etiqueta" => "2"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Motor competence and health related physical fitness in youth&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;T&#46; Cattuzzo"
                            1 => "R&#46;H&#46; dos Santos"
                            2 => "A&#46;H&#46; R&#233;"
                            3 => "I&#46;S&#46; de Oliveira"
                            4 => "B&#46;M&#46; Melo"
                            5 => "M&#46;M&#46; de Sousa"
                          ]
                        ]
                      ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.jsams.2014.12.004"
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                        "tituloSerie" => "J Sci Med Sport"
                        "fecha" => "2016"
                        "volumen" => "19"
                        "paginaInicial" => "123"
                        "paginaFinal" => "129"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25554655"
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              "etiqueta" => "3"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fundamental movement skills in children and adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            0 => "D&#46;R&#46; Lubans"
                            1 => "P&#46;J&#46; Morgan"
                            2 => "D&#46;P&#46; Cliff"
                            3 => "L&#46;M&#46; Barnett"
                            4 => "A&#46;D&#46; Okely"
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                        "tituloSerie" => "Sport Med"
                        "fecha" => "2010"
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                        "paginaInicial" => "1019"
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              "identificador" => "bib0165"
              "etiqueta" => "4"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relationship of fundamental movement skills and physical activity in children and adolescents&#58; a systematic review"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46; Holfelder"
                            1 => "N&#46; Schott"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Psychol Sport Exerc"
                        "fecha" => "2014"
                        "volumen" => "15"
                        "paginaInicial" => "382"
                        "paginaFinal" => "391"
                      ]
                    ]
                  ]
                ]
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            4 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Motor competence and its effect on positive developmental trajectories of health"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46;E&#46; Robinson"
                            1 => "D&#46;F&#46; Stodden"
                            2 => "L&#46;M&#46; Barnett"
                            3 => "V&#46;P&#46; Lopes"
                            4 => "S&#46;W&#46; Logan"
                            5 => "L&#46;P&#46; Rodrigues"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s40279-015-0351-6"
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                        "tituloSerie" => "Sports Med"
                        "fecha" => "2015"
                        "volumen" => "45"
                        "paginaInicial" => "1273"
                        "paginaFinal" => "1284"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26201678"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            5 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relationship between motor skill and body mass index in 5- to 10-year-old children"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46;E&#46; Hondt"
                            1 => "B&#46; Deforche"
                            2 => "I&#46; De Bourdeaudhuij"
                            3 => "M&#46; Lenoir"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Adapt Phys Act Q"
                        "fecha" => "2009"
                        "volumen" => "26"
                        "paginaInicial" => "21"
                        "paginaFinal" => "37"
                      ]
                    ]
                  ]
                ]
              ]
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            6 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gross motor coordination in relation to weight status and age in 5- to 12-year-old boys and girls&#58; a cross-sectional study"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; D&#8217;Hondt"
                            1 => "B&#46; Deforche"
                            2 => "R&#46; Vaeyens"
                            3 => "B&#46; Vandorpe"
                            4 => "J&#46; Vandendriessche"
                            5 => "J&#46; Pion"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/17477166.2010.500388"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Pediatr Obes"
                        "fecha" => "2011"
                        "volumen" => "6"
                        "paginaInicial" => "e556"
                        "paginaFinal" => "e564"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20973659"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0185"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The association between motor skill competence and physical fitness in young adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46; Stodden"
                            1 => "S&#46; Langendorfer"
                            2 => "M&#46;A&#46; Roberton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/02701367.2009.10599556"
                      "Revista" => array:6 [
                        "tituloSerie" => "Res Q Exerc Sport"
                        "fecha" => "2009"
                        "volumen" => "80"
                        "paginaInicial" => "223"
                        "paginaFinal" => "229"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19650387"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0190"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Weight status is associated with cross-sectional trajectories of motor co-ordination across childhood"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "V&#46;P&#46; Lopes"
                            1 => "D&#46;F&#46; Stodden"
                            2 => "L&#46;P&#46; Rodrigues"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/cch.12127"
                      "Revista" => array:6 [
                        "tituloSerie" => "Child Care Health Dev"
                        "fecha" => "2014"
                        "volumen" => "40"
                        "paginaInicial" => "891"
                        "paginaFinal" => "899"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24354776"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0195"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Changes in physical fitness and sports participation among children with different levels of motor competence&#58; a 2-year longitudinal study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Fransen"
                            1 => "D&#46; Deprez"
                            2 => "J&#46; Pion"
                            3 => "I&#46;B&#46; Tallir"
                            4 => "E&#46; D&#8217;Hondt"
                            5 => "R&#46; Vaeyens"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1123/pes.2013-0005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Exerc Sci"
                        "fecha" => "2014"
                        "volumen" => "26"
                        "paginaInicial" => "11"
                        "paginaFinal" => "21"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24018944"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A developmental perspective on the role of motor skill competence in physical activity&#58; an emergent relationship"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;F&#46; Stodden"
                            1 => "J&#46;D&#46; Goodway"
                            2 => "S&#46;J&#46; Langendorfer"
                            3 => "M&#46;A&#46; Roberton"
                            4 => "M&#46;E&#46; Rudisill"
                            5 => "C&#46; Garcia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Quest"
                        "fecha" => "2008"
                        "volumen" => "60"
                        "paginaInicial" => "290"
                        "paginaFinal" => "306"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Changes in motor skill and fitness measures among children with high and low motor competence&#58; a five-year longitudinal study"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "B&#46; Hands"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jsams.2007.02.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Sci Med Sport"
                        "fecha" => "2008"
                        "volumen" => "11"
                        "paginaInicial" => "155"
                        "paginaFinal" => "162"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17567536"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Is developmental coordination disorder a fundamental cause of inactivity and poor health-related fitness in children&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Cairney"
                            1 => "S&#46; Veldhuizen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/dmcn.12308"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dev Med Child Neurol"
                        "fecha" => "2013"
                        "volumen" => "55"
                        "paginaInicial" => "55"
                        "paginaFinal" => "58"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24237281"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "effects of a three-year intervention&#58; the Copenhagen School Child Intervention Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Bugge"
                            1 => "B&#46; El-Naaman"
                            2 => "M&#46; Dencker"
                            3 => "K&#46; Froberg"
                            4 => "I&#46;M&#46; Holme"
                            5 => "R&#46;G&#46; McMurray"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Sci Sport Exerc"
                        "fecha" => "2012"
                        "volumen" => "44"
                        "paginaInicial" => "1310"
                        "paginaFinal" => "1317"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maximum oxygen uptake and objectively measured physical activity in Danish children 6&#8211;7 years of age&#58; the Copenhagen school child intervention study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46; Eiberg"
                            1 => "H&#46; Hasselstrom"
                            2 => "V&#46; Gr&#248;nfeldt"
                            3 => "K&#46; Froberg"
                            4 => "J&#46; Svensson"
                            5 => "L&#46;B&#46; Andersen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bjsm.2004.015230"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Sports Med"
                        "fecha" => "2005"
                        "volumen" => "39"
                        "paginaInicial" => "725"
                        "paginaFinal" => "730"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16183768"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Validation of the COSMED K4 b2 Portable Metabolic System"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;E&#46; McLaughlin"
                            1 => "G&#46;A&#46; King"
                            2 => "E&#46;T&#46; Howley"
                            3 => "D&#46;R&#46; Bassett Jr&#46;"
                            4 => "B&#46;E&#46; Ainsworth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-2001-13816"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Sports Med"
                        "fecha" => "2001"
                        "volumen" => "22"
                        "paginaInicial" => "280"
                        "paginaFinal" => "284"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11414671"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A metabolic cart for measurement of oxygen uptake during human exercise using inspiratory flow rate"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46; Jensen"
                            1 => "S&#46; J&#248;rgensen"
                            2 => "L&#46; Johansen"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00421-002-0616-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Appl Physiol"
                        "fecha" => "2002"
                        "volumen" => "87"
                        "paginaInicial" => "202"
                        "paginaFinal" => "206"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12111279"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Normal growth and techniques of growth assessment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;M&#46; Tanner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Endocrinol Metab"
                        "fecha" => "1986"
                        "volumen" => "15"
                        "paginaInicial" => "411"
                        "paginaFinal" => "451"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3769221"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "K&#246;rperkoordinationstest f&#252;r Kinder 2&#46; Beltz Test&#46; G&#246;ttingen"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46; Kiphard"
                            1 => "F&#46; Schilling"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2007"
                        "editorial" => "&#220;berarbeitete und erg&#228;nzte Auflage"
                        "editorialLocalizacion" => "Germany"
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                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A longitudinal analysis of gross motor coordination in overweight and obese children <span class="elsevierStyleItalic">versus</span> normal-weight peers"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; D&#8217;Hondt"
                            1 => "B&#46; Deforche"
                            2 => "I&#46; Gentier"
                            3 => "I&#46; De Bourdeaudhuij"
                            4 => "R&#46; Vaeyens"
                            5 => "R&#46; Philippaerts"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Obes &#40;Lond&#41;"
                        "fecha" => "2013"
                        "volumen" => "37"
                        "paginaInicial" => "61"
                        "paginaFinal" => "67"
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0250"
              "etiqueta" => "21"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Motor coordination&#44; physical activity and fitness as predictors of longitudinal change in adiposity during childhood"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "V&#46;P&#46; Lopes"
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                            2 => "L&#46;P&#46; Rodrigues"
                            3 => "R&#46; Malina"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur J Sport Sci"
                        "fecha" => "2012"
                        "volumen" => "12"
                        "paginaInicial" => "384"
                        "paginaFinal" => "391"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Motor competence and cardiorespiratory fitness have greater influence on body fatness than physical activity across time"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
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                            1 => "K&#46;A&#46; Pfeiffer"
                            2 => "A&#46; Bugge"
                            3 => "N&#46;C&#46; M&#248;ller"
                            4 => "L&#46;B&#46; Andersen"
                            5 => "D&#46;F&#46; Stodden"
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                        ]
                      ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/sms.12850"
                      "Revista" => array:6 [
                        "tituloSerie" => "Scand J Med Sci Sports"
                        "fecha" => "2017"
                        "volumen" => "27"
                        "paginaInicial" => "1638"
                        "paginaFinal" => "1647"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28164374"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0260"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Partitioning variation in multilevel models"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46; Goldstein"
                            1 => "W&#46; Browne"
                            2 => "J&#46; Rasbash"
                          ]
                        ]
                      ]
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                  "host" => array:1 [
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                ]
              ]
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                          "etal" => false
                          "autores" => array:3 [
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                          "etal" => false
                          "autores" => array:4 [
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                        "paginaInicial" => "40"
                        "link" => array:1 [
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                        "paginaFinal" => "1201"
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Journal Information
Vol. 95. Issue 4.
Pages 482-488 (July - August 2019)
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3310
Vol. 95. Issue 4.
Pages 482-488 (July - August 2019)
Original article
Open Access
The longitudinal relationship between motor competence and measures of fatness and fitness from childhood into adolescence
Relação longitudinal entre a coordenação motora e as medidas de gordura e aptidão física da infância à adolescência
Visits
3310
Rodrigo Antunes Limaa,b,
Corresponding author
rodrigoantlima@gmail.com

Corresponding author.
, Anna Buggeb, Annette K. Ersbøllc, David F. Stoddend, Lars B. Andersene,f
a Ministério da Educação, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes), Brasília, DF, Brazil
b University of Southern Denmark, Institute for Sport Science and Clinical Biomechanics, Center for Research in Childhood Health, Campusvej, Denmark
c University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
d University of South Carolina, Yvonne & Schuyler Moore Child Development Research Center, Columbia, United States
e Western Norway University of Applied Sciences, Sogndal, Norway
f Norwegian School of Sport Sciences, Department of Sports Medicine, Oslo, Norway
This item has received

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Abstract
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Table 1. Mean (SD) physical and motor characteristics of participants by age and sex.
Abstract
Objectives

To examine longitudinal (seven years) relationships among cardiorespiratory fitness (VO2peak), body fatness, and motor competence.

Method

Data were collected as part of the Copenhagen School Child Intervention Study (CoSCIS). Body fatness was assessed by the sum of four skinfolds. VO2peak was measured directly in a continuous running protocol. Motor competence was assessed using the Körperkoordinationtest für Kinder. This study used multilevel linear mixed models to evaluate the reciprocal longitudinal association between body fatness, VO2peak, and motor competence. All regressions were stratified by sex and adjusted by intervention and pubertal status. All variable coefficients were standardized.

Results

A reciprocal relationship was observed between children's motor competence with body fatness and VO2peak at the seven-year follow-up (6–13 years of age). Children with higher motor competence at baseline had a lower risk of having higher body fatness (βboys=−0.45, 95% CI: −0.52 to −0.38; βgirls=−0.35, 95% CI: −0.42 to −0.28) and higher VO2peak (βboys=0.34, 95% CI: 0.27–0.40; βgirls=0.27, 95% CI: 0.20–0.33) during childhood. Alternatively, higher body fatness or lower levels of VO2peak at baseline were associated with lower motor competence during childhood.

Conclusions

These data suggest motor competence, body fatness, and VO2peak demonstrate reciprocal relationships across childhood (6–13 years of age). Interventions addressing motor competence, cardiorespiratory fitness, and body fatness in early childhood are recommended, as intervention effects are likely to be enhanced because of the mutual reciprocal associations between these three variables.

Keywords:
Motor development
Longitudinal studies
Health behavior
Risk factors
Obesity
Physical fitness
Resumo
Objetivos

Examinar as relações longitudinais (sete anos) entre a aptidão cardiorrespiratória (VO2 pico), gordura corporal e coordenação motora.

Método

Os dados foram coletados como parte do Copenhagen School Child Intervention Study (CoSCIS). A gordura corporal foi avaliada pela soma de quatro dobras cutâneas. O VO2 pico foi medido diretamente em um protocolo de corrida contínua. A coordenação motora foi avaliada com o teste de coordenação corporal para crianças (Körperkoordination für Kinder – KTK). Usamos modelos lineares mistos multiníveis para avaliar a associação longitudinal recíproca entre a gordura corporal, o VO2 pico e a coordenação motora. Todas as regressões foram estratificadas por sexo e ajustadas para intervenção e estado puberal. Todos os coeficientes das variáveis foram padronizados.

Resultados

Observamos uma relação recíproca entre a coordenação motora e a gordura corporal. As crianças com maior coordenação motora no início do estudo apresentaram menor risco de ter maior nível de gordura corporal (βmeninos=-0,45, IC de 95%: -0,52: -0,38; βmeninas=-0,35, IC de 95%: -0,42: -0,28) e maior VO2 pico (βmeninos=0,34, IC de 95%: 0,27: 0,40; βmeninas=0,27, IC de 95%: 0,20: 0,33). Por outro lado, maior nível de gordura corporal ou menores níveis de VO2 pico no início do estudo foram associados a menor coordenação motora durante a infância.

Conclusões

Esses dados sugerem que a coordenação motora, gordura corporal e VO2 pico demonstram relações recíprocas durante a infância (6-13 anos). São recomendadas intervenções que abordem a coordenação motora, a aptidão cardiorrespiratória e a gordura corporal na primeira infância, pois os efeitos da intervenção são provavelmente maiores devido às associações recíprocas mútuas entre essas três variáveis.

Palavras-chave:
Desenvolvimento motor
Estudos longitudinais
Comportamento saudável
Fatores de risco
Obesidade
Aptidão física
Full Text
Introduction

Motor competence (MC) is indispensable for many functional and purposeful tasks in daily life, sports, and recreational activities. Alongside strength and power, MC is reflective of the cooperative function of the central and peripheral nervous systems and the musculoskeletal system.1 Recent research has demonstrated strong evidence of associations between MC and cardiorespiratory fitness,2,3 body weight status,2,3 and physical activity,3,4 suggesting that MC may have an important impact on children's health.3,5

Association between MC and body weight status is observed even in early childhood (5 years)6,7 and continues through early adulthood.8 Specifically, Lopes et al.9 and D’Hondt et al.7 analyzed cross-sectional associations between gross MC and weight status in children ages 6–14 and 5–12 years old, respectively, and noted that children with higher MC scores already demonstrated lower BMI at 5–6 years old. In addition, the inverse strength of associations between MC and BMI became larger with increasing age. Fransen et al.10 also observed the same phenomenon with two-year longitudinal data. Importantly, associations between MC and BMI were not mediated by physical activity in this study.10 Data from the previously mentioned studies and others provide indirect support for a heuristic model that proposes MC and body weight status will demonstrate reciprocal relationships across childhood, with increasing strengths of association across childhood.5,11

The model also proposes that MC and aspects of health-related physical fitness (i.e., cardiorespiratory endurance, muscular strength/endurance) will demonstrate the same reciprocal relationships across childhood. Recent review articles generally support these views.2,3,5 Cardiorespiratory fitness is consistently correlated with MC in children and adolescents, with recent a systematic review noting that 12 out of 12 studies demonstrated positive associations between MC and cardiorespiratory fitness.2 The development of gross MC promotes independent upright posture and locomotion in early childhood, which is suggested to influence the early improvement of cardiorespiratory fitness in children11via the repetitive nature of movement exploration (e.g., crawling, walking). Hands12 and Cairney and Veldhuizen13 observed that motorically delayed children had lower cardiorespiratory fitness performance compared to peers with higher gross motor coordination, with the difference remaining after two to five years of follow-up.

While the aforementioned cross-sectional and longitudinal data provide strong evidence for consistent inverse associations between MC and weight status and positive associations between MC and cardiorespiratory fitness, a causal pathway between these variables is still not clear. Recently, Robinson et al.5 compiled the literature that investigated the potential impact of MC on health-related factors. In summary, the authors noted that cardiorespiratory fitness (positively) and fatness (negatively) were longitudinally associated with MC during childhood. However, the possible reciprocal association between MC and fitness and fatness has not been fully addressed.

It is important to test whether relationships between MC, cardiorespiratory fitness, and fatness are reciprocal to provide knowledge to more successful interventions aiming to increase MC and fitness levels and decrease fatness during childhood and adolescence. This evidence can also support policy makers designing policies for this population. To provide a more comprehensive understanding of the long-term relationships between the health-related components of MC, cardiorespiratory fitness, and fatness, the authors analyzed the longitudinal associations (seven-year span from childhood into beginning adolescence) among fitness (VO2peak), fatness (sum of four skinfolds), and MC levels, and the potential reciprocal nature of these associations. More specifically, the strengths of the relationships among these variables were evaluated over time.

Material and methods

This study was based on longitudinal analysis of data from the Copenhagen School Child Intervention Study (CoSCIS), which began in 2001. Children attending preschool class in two communities in the area of Copenhagen (46 preschool classes in 18 schools) were recruited to participate in the study. CoSCIS is a controlled longitudinal intervention study that took place in 18 public schools (ten interventions and eight controls) in two suburbs of Copenhagen. The local Authority of Ballerup had decided to upgrade the physical activity opportunities for their youngest schoolchildren and contacted the research group to quantify and measure the effect of such an intervention. The intervention was hereafter planned in cooperation between the local authority and the researchers. All children from 46 preschool classes (age 6–7 years) in the schools in the two local authorities were invited to participate in the study.14 The study was approved by the ethical committee, University of Copenhagen (reference KA00011gm). Written informed consent was obtained from the parents/guardians of 706 children (69% of the population), and 696 actually participated in the study at baseline. The intervention lasted three years and no key variables examined in this study were affected by the intervention.14 Children were followed up again in 2008 at 13 years.

Because the complete methodology has been previously published,14 the methodology here presents only those variables of interest. Bicipital, tricipital, subscapular, and suprailiac skinfolds were measured on the self-reported nondominant side of the body by the same two skilled researchers with a Harpender skinfold caliper (Harpender, West Sussex, United Kingdom), and fatness was computed as the sum of the four skinfolds (S4SF). Cardiorespiratory fitness (VO2peak) was assessed using a continuous running protocol on a treadmill until exhaustion. VO2peak was measured directly on an AMIS 2001 Cardiopulmonary Function Test System (Innovision, Odense, Denmark) at 6 and 9 years-of-age, and using a COSMED K4b2 portable metabolic system (COSMED, Rome, Italy) at 13 years-of-age. Both systems provide valid measures of VO2 when validated against the Douglas bag method.15–17 From 9 to 13 years of age, the pubertal status was reported using the Tanner scale,18 with pictures of breasts for girls and genital development for boys.

MC was assessed using the Körperkoordinationstest für Kinder (KTK), which is a standardized normative German test battery.19 The KTK has high test-retest reliability (0.90 to 0.97).19 It consists of four independent tests: (1) walking backwards on balance beams of decreasing width: 6.0, 4.5, and 3.0cm (KTKBEAM), (2) moving sideways on wooden boards for 20s (KTKBOARD), (3) one-legged hopping over a foam obstacle with increasing height in consecutive steps of 5cm (KTKHOP), and (4) two-legged jumping from side to side for 15s (KTKJUMP). The KTK battery has been used in numerous studies to evaluate MC performance levels in normally developing children and adolescents up to 15 years-of-age.20,21 The raw performance score on each item was summed and standardized in Z-scores (KTK Z-score) to evaluate the longitudinal association between the S4SF, VO2peak, and MC.

In all analyses, STATA version 13.0 was used (StataCorp, College Station, TX, USA). We performed multilevel linear regressions to evaluate the reciprocal longitudinal association between VO2peak, S4SF, and MC, and how this possible reciprocal longitudinal association would develop over time. Therefore, it was analyzed whether VO2peak and S4SF (exposure variables) influence MC (outcome) development, and also whether MC (exposure variable) impacts the development of VO2peak and S4SF (outcomes). Note that independent multilevel linear regressions were performed to evaluate the relationships between MC and VO2peak, and between MC and S4SF. Therefore, VO2peak and S4SF were not in the same regression models. Standardized β coefficients are presented for each testing time (results in figures) and the overall longitudinal relationship over seven years of follow-up (results in text), both provided by the same multilevel models. Standardized β coefficients are presented to help readers to compare the strength between coefficients. This approach has been used previously.22 Children with missing information in one of the three measuring points were included in the analyses. The hierarchical data structure was taken into account with students nested in school classes, and school classes nested in schools (random effects). The regressions were adjusted for group (intervention; control), and pubertal status (prepubertal, initial puberty, and puberty). All the analyses were stratified by sex (boys and girls).

In all multilevel regression models, the variance related to the clusters (school and classes within school) and the intraclass correlation coefficient (ICC) were calculated for each model to interpret the variation between school classes, classes, and individuals.23,24 In all regression models, the majority of the variation (ICC) was based on the individual level (the conjugated ICCs from school and classes were always below 5%). All regression models were tested for linearity between dependent and independent variables; normality of the regression equation residuals; and the variance equality of the equation residuals.

Results

The majority of the boys at 9 years of age were in the initial stages of genitalia development (95.4% in stage 1 and 4.6% in stage 2). At 13 years of age, most of the boys characterized themselves in stage 3 in genitalia development (45.7%), followed by stage 4 (40.3%), stages 2 and 5 (6.3% each), and stage 1 (1.4%). At 9 years of age, 54.7% of the girls recognized themselves as being in stage 1 regarding their breast development, while 40.4% reported being in stage 2 and 4.9% reported being in stage 3. At 13 years of age, most of the girls characterized themselves as being in stage 4 (55.3%), 23.3% reported being in stage 3, 15.2% reported being in stage 5, 5.7% reported being in stage 2, and 0.5% reported being in stage 1.

Table 1 presents the physical and motor characteristics of the participants in each age period of monitoring. Differences were observed in VO2peak and S4SF between boys and girls in all age ranges.

Table 1.

Mean (SD) physical and motor characteristics of participants by age and sex.

  AllBoysGirls
  6 years  9 years  13 years  6 years  9 years  13 years  6 years  9 years  13 years 
n  696  615  442  369  323  231  327  292  211 
Age (years)  6.75 (0.37)  9.59 (1.07)  13.35 (0.34)  6.81 (0.37)  9.59 (1.31)  13.39 (0.34)  6.67 (0.35)  9.58 (0.71)  13.31 (0.33) 
KTK score  119.18 (27.66)  195.17 (34.64)  249.40 (29.41)  120.07 (28.42)  194.77 (34.89)  251.37 (29.88)  118.18 (26.79)  195.62 (34.42)  247.26 (28.81) 
VO2peaka (mLkg−1min−146.71 (5.97)  49.06 (7.14)  49.27 (8.69)  48.45 (5.93)  51.80 (6.81)  53.18 (8.37)  44.75 (5.38)  45.93 (6.15)  45.17 (6.96) 
S4SFa (mm)  26.62 (9.97)  33.56 (16.46)  34.93 (16.83)  24.35 (8.95)  30.13 (14.52)  31.63 (16.96)  29.18 (10.43)  37.37 (17.62)  38.54 (15.93) 

KTK, Körperkoordinationtest für Kinder; S4SF, sum the four skinfolds.

a

p<0.05 significant difference between boys and girls in all ages.

Reciprocal longitudinal relationship between MC and S4SF

Results indicated MC and S4SF demonstrated a reciprocal influence on each other across time for both boys and girls. For both boys and girls, S4SF had a stronger association in the development of MC (βboys=−0.45 Z-scores, 95% CI: −0.52 to −0.38; βgirls=−0.35 Z-scores, 95% CI: −0.42 to −0.28), as opposed to MC influencing the development of S4SF (βboys=−0.31 Z-scores, 95% CI: −0.36 to −0.26; βgirls=−0.26 Z-scores, 95% CI: −0.31 to −0.20). The strength of the longitudinal association between MC and S4SF was also evaluated over time. For boys, the strength of the association between MC and S4SF increased across follow-up time points, independent of the direction analyzed. While for girls, an increase in the strength of the association was observed from 6 to 9 years-of-age, and maintenance of the strength of the association from 9 to 13 years-of-age, independent of the direction analyzed (Fig. 1).

Figure 1.

Parameter estimates of the slope for the association between S4SF and MC at 6, 9, and 13 years of age. (a) Gray line: S4SF (exposure) and MC (outcome); (b) black line: MC (exposure) and S4SF (outcome). Adjusted for: group (intervention; control), and pubertal status (prepubertal, initial puberty and puberty).

S4SF, sum the four skinfolds; MC, motor competence.

(0.13MB).
Reciprocal longitudinal relationship between MC and VO2peak

Independent of sex, MC and VO2peak also demonstrated reciprocal relationships across time. Although for boys, MC demonstrated a stronger influence on VO2peak (βboys=0.34 Z-scores, 95% CI: 0.27–0.40), as opposed to the influence of VO2peak on the development of MC (βboys=0.24 Z-scores, 95% CI: 0.18–0.30). While for girls, results did not demonstrate a marked differential effect of one variable on the development of the other variable across time (VO2peakMC; βgirls=0.25 Z-scores, 95% CI: 0.18–0.32) (MCVO2peak; βgirls=0.27 Z-scores, 95% CI: 0.20–0.33). Evaluating the pattern of associations between MC and VO2peak across the time points in boys, independent of the direction analyzed, it was possible to observe an increase in the strength of the association from 6 to 9 years-of-age and a subsequent maintenance at 13 years-of-age. While for girls, the strength of the association that MC had on the development of VO2peak was relatively stable during the follow-up period (0.24β0.30). On the other hand, the impact of VO2peak on MC increased from 6 to 9 years-of-age and stabilized from nine to 13 years-of-age (Fig. 2).

Figure 2.

Parameter estimates of the slope for the association between VO2peak and MC at 6, 9, and 13 years of age. (a) Gray line: VO2peak (exposure) and MC (outcome); (b) black line: MC (exposure) and VO2peak (outcome). Adjusted for: group (intervention; control), and pubertal status (prepubertal, initial puberty, and puberty). MC, motor competence.

(0.11MB).
Discussion

Overall, this study observed a reciprocal relationship between children's MC with S4SF and VO2peak across the seven-year follow-up (6–13 years of age). Children with lower MC performance at baseline had higher risk of having higher S4SF and lower VO2peak during childhood. Alternatively, higher S4SF or lower levels of VO2peak at baseline were associated with lower MC development across time. Except for the stable longitudinal relationship between MC and VO2peak for girls, the strength of the association between MC and S4SF and VO2peak increased from 6 to 9 years of age and then was fairly stable from 9 to 13 years of age in both boys and girls, independent of the direction analyzed (MCS4SF, S4SFMC; MCVO2peak, VO2peakMC).

To the best of our knowledge, this is the first long-term follow-up study (seven years) to evaluate the potential reciprocal relationship between MC and S4SF that also evaluated the strength of the association over time. Robinson et al.5 also noted the lack of literature addressing these important developmental findings and thus, these data add to the existing literature in this area. As most previous studies addressing these variables used BMI as their assessment of obesity status, the use of skinfolds in the present study provided a more valid measure of body fat across childhood and into adolescence, when BMI becomes a less valid measure of obesity.25 The current data expand on previous four-year longitudinal data published by Lopes et al.,21 who also observed that children with higher MC at baseline demonstrated lower body fatness across time, as measured by the sum of skinfolds. Overall, the mutual relationship between MC and body fat across childhood suggests the need to consistently address them, via intervention on both factors to potentialize the effects of the intervention.

The present study partially supports the heuristic model proposed by Stodden et al.,11 which hypothesizes that MC and body weight status will demonstrate reciprocal relationships across childhood with increasing strengths of associations across childhood. It is logical that heavier children face problems to be active and develop their MC, as compared to their normal weight peers. Alternatively, children who demonstrate lower MC demonstrate less success and enjoyment in many developmentally appropriate activities (e.g., sports and games); thus, they are less likely to continue to participate in activities that inherently demand various forms of MC.11 This further hinders MC development and physical activity participation, and promotes negative developmental trajectories of MC, weight status, and fitness.26 In fact, it was possible to observe reciprocal associations between S4SF and MC that became stronger across age (boys: increase during the whole period of monitoring) or remained stable (girls: increase until 9 years of age with subsequent stabilization), which could mean that successful intervention with a focus on both unhealthy weight gain (i.e., nutrition and physical activity) and low MC in early childhood might have greater sustained impact across childhood.26

Of course, children's cardiovascular endurance is not independent from either obesity or MC. The demonstrated reciprocal relationship between MC and cardiovascular endurance partially demonstrates this affect. Few studies have analyzed the association between MC and fitness level longitudinally,2,12,27 but to the best of our knowledge, none have analyzed if MC and VO2peak mutually influence the development of each other during childhood. In particular, the majority of studies have only looked at the influence of MC on physical fitness.5 It has been shown that lower MC negatively influences cardiorespiratory fitness development.10,12,28 In a six-year follow-up study (10 year-old children at baseline), Barnett et al.27 observed that MC at baseline predicted the fitness level in Australian children. Complementarily, perceived sports competence mediated this relationship. It was interesting to note that the present data indicated MC has a larger suggested impact on VO2peak development than the reverse causality from 6 to 9 years-of-age. However, from ages of 9 to 13 or for girls, the regression models did not demonstrate stronger relationships in either direction. According to these results, the capability to successfully participate in many different activities that inherently require adequate levels of MC probably generates more opportunities to be physically active, thus leading to higher cardiorespiratory fitness and decreased body fatness.11 Subsequently, higher cardiorespiratory fitness would allow for longer participation, and a higher chance to develop better MC.11

In particular, the different pattern of the relationships between MC, S4SF, and VO2peak for boys and girls might be partially explained by their pubertal status. Because MC, S4SF, and VO2peak did not differ for boys and girls due to the effects of the initial intervention that was conducted from the ages of 6 to 9 years14 and because girls reach higher pubertal status sooner than boys, it is possible that the physical development was being influenced by their maturational status. In addition, the fact that girls decrease their participation in physical activities sooner than boys might also influence the pattern of the relationships between MC, S4SF, and VO2peak.29

This study had some limitations that have to be considered in the interpretation of the results. This longitudinal study was part of an intervention project and some results could be influenced by the intervention; however, this study presented a follow-up of four years after the intervention ended and the analyses were adjusted for group (intervention, control). In addition, the intervention did not influence MC development, VO2peak, or S4SF.14 Longitudinal studies provide valuable inferences about causal mechanisms; however, evidence for causality would be further strengthened with experimental evidence. It would be valuable to assess pubertal status by a more precise measure. Some of the differences in the associations between boys and girls might be explained by differences in pubertal status. Another limitation is the fact that the nutrition/diet and physical activity level of the participants were not accounted for in the study, which may have influenced the association between variables.

The development of MC, S4SF, and VO2peak trajectories across childhood and into adolescence (6–13 years of age) seems to be the result of reciprocal mechanisms. It seems logical that interventions should address MC, cardiorespiratory fitness, and other factors associated with body fatness in early childhood, as early intervention effects are likely to be enhanced because of the reciprocal and potentially synergistic associations between these three variables across time. As noted, by the increasing strength of associations across both time points or in at least one longitudinal time point, promoting MC, fitness, and a healthy weight status in early childhood can promote positive developmental trajectories of these variables across childhood and into adolescence.

Funding

This work was supported by a CAPES Scholarship, number: 1361/13-9, The Danish Heart Foundation, and TrygFonden.

Conflicts of interest

The authors declare no conflicts of interest.

Acknowledgments

The authors are thankful to all participating children and their families, school principals, and teachers, and the politicians and employees of the local authorities of Ballerup and Tårnby.

References
[1]
E. Katartzi, E. Gantiraga, C. Papadopoulos, G. Komsis.
The relationship between specific strength components of lower limbs and vertical jumping ability in school-aged children.
J Hum Mov Stud, 48 (2005), pp. 227-243
[2]
M.T. Cattuzzo, R.H. dos Santos, A.H. Ré, I.S. de Oliveira, B.M. Melo, M.M. de Sousa, et al.
Motor competence and health related physical fitness in youth: a systematic review.
J Sci Med Sport, 19 (2016), pp. 123-129
[3]
D.R. Lubans, P.J. Morgan, D.P. Cliff, L.M. Barnett, A.D. Okely.
Fundamental movement skills in children and adolescents.
Sport Med, 40 (2010), pp. 1019-1035
[4]
B. Holfelder, N. Schott.
Relationship of fundamental movement skills and physical activity in children and adolescents: a systematic review.
Psychol Sport Exerc, 15 (2014), pp. 382-391
[5]
L.E. Robinson, D.F. Stodden, L.M. Barnett, V.P. Lopes, S.W. Logan, L.P. Rodrigues, et al.
Motor competence and its effect on positive developmental trajectories of health.
Sports Med, 45 (2015), pp. 1273-1284
[6]
D.E. Hondt, B. Deforche, I. De Bourdeaudhuij, M. Lenoir.
Relationship between motor skill and body mass index in 5- to 10-year-old children.
Adapt Phys Act Q, 26 (2009), pp. 21-37
[7]
E. D’Hondt, B. Deforche, R. Vaeyens, B. Vandorpe, J. Vandendriessche, J. Pion, et al.
Gross motor coordination in relation to weight status and age in 5- to 12-year-old boys and girls: a cross-sectional study.
Int J Pediatr Obes, 6 (2011), pp. e556-e564
[8]
D. Stodden, S. Langendorfer, M.A. Roberton.
The association between motor skill competence and physical fitness in young adults.
Res Q Exerc Sport, 80 (2009), pp. 223-229
[9]
V.P. Lopes, D.F. Stodden, L.P. Rodrigues.
Weight status is associated with cross-sectional trajectories of motor co-ordination across childhood.
Child Care Health Dev, 40 (2014), pp. 891-899
[10]
J. Fransen, D. Deprez, J. Pion, I.B. Tallir, E. D’Hondt, R. Vaeyens, et al.
Changes in physical fitness and sports participation among children with different levels of motor competence: a 2-year longitudinal study.
Pediatr Exerc Sci, 26 (2014), pp. 11-21
[11]
D.F. Stodden, J.D. Goodway, S.J. Langendorfer, M.A. Roberton, M.E. Rudisill, C. Garcia, et al.
A developmental perspective on the role of motor skill competence in physical activity: an emergent relationship.
Quest, 60 (2008), pp. 290-306
[12]
B. Hands.
Changes in motor skill and fitness measures among children with high and low motor competence: a five-year longitudinal study.
J Sci Med Sport, 11 (2008), pp. 155-162
[13]
J. Cairney, S. Veldhuizen.
Is developmental coordination disorder a fundamental cause of inactivity and poor health-related fitness in children?.
Dev Med Child Neurol, 55 (2013), pp. 55-58
[14]
A. Bugge, B. El-Naaman, M. Dencker, K. Froberg, I.M. Holme, R.G. McMurray, et al.
effects of a three-year intervention: the Copenhagen School Child Intervention Study.
Med Sci Sport Exerc, 44 (2012), pp. 1310-1317
[15]
S. Eiberg, H. Hasselstrom, V. Grønfeldt, K. Froberg, J. Svensson, L.B. Andersen.
Maximum oxygen uptake and objectively measured physical activity in Danish children 6–7 years of age: the Copenhagen school child intervention study.
Br J Sports Med, 39 (2005), pp. 725-730
[16]
J.E. McLaughlin, G.A. King, E.T. Howley, D.R. Bassett Jr., B.E. Ainsworth.
Validation of the COSMED K4 b2 Portable Metabolic System.
Int J Sports Med, 22 (2001), pp. 280-284
[17]
K. Jensen, S. Jørgensen, L. Johansen.
A metabolic cart for measurement of oxygen uptake during human exercise using inspiratory flow rate.
Eur J Appl Physiol, 87 (2002), pp. 202-206
[18]
J.M. Tanner.
Normal growth and techniques of growth assessment.
Clin Endocrinol Metab, 15 (1986), pp. 411-451
[19]
E. Kiphard, F. Schilling.
Körperkoordinationstest für Kinder 2. Beltz Test. Göttingen.
Überarbeitete und ergänzte Auflage, (2007),
[20]
E. D’Hondt, B. Deforche, I. Gentier, I. De Bourdeaudhuij, R. Vaeyens, R. Philippaerts, et al.
A longitudinal analysis of gross motor coordination in overweight and obese children versus normal-weight peers.
Int J Obes (Lond), 37 (2013), pp. 61-67
[21]
V.P. Lopes, J.A. Maia, L.P. Rodrigues, R. Malina.
Motor coordination, physical activity and fitness as predictors of longitudinal change in adiposity during childhood.
Eur J Sport Sci, 12 (2012), pp. 384-391
[22]
R.A. Lima, K.A. Pfeiffer, A. Bugge, N.C. Møller, L.B. Andersen, D.F. Stodden.
Motor competence and cardiorespiratory fitness have greater influence on body fatness than physical activity across time.
Scand J Med Sci Sports, 27 (2017), pp. 1638-1647
[23]
H. Goldstein, W. Browne, J. Rasbash.
Partitioning variation in multilevel models.
Underst Stat, 1 (2002), pp. 223-231
[24]
J. Merlo, B. Chaix, H. Ohlsson, A. Beckman, K. Johnell, P. Hjerpe, et al.
A brief conceptual tutorial of multilevel analysis in social epidemiology: using measures of clustering in multilevel logistic regression to investigate contextual phenomena.
J Epidemiol Commun Health, 60 (2006), pp. 290-297
[25]
E. D’Hondt, B. Deforche, I. Gentier, J. Verstuyf, R. Vaeyens, I. De Bourdeaudhuij, et al.
A longitudinal study of gross motor coordination and weight status in children.
Obesity, 22 (2014), pp. 1505-1511
[26]
L.P. Rodrigues, D.F. Stodden, V.P. Lopes.
Developmental pathways of change in fitness and motor competence are related to overweight and obesity status at the end of primary school.
J Sci Med Sport, 19 (2016), pp. 87-92
[27]
L.M. Barnett, P.J. Morgan, E. van Beurden, J.R. Beard.
Perceived sports competence mediates the relationship between childhood motor skill proficiency and adolescent physical activity and fitness: a longitudinal assessment.
Int J Behav Nutr Phys Act, 5 (2008), pp. 40
[28]
J. Cairney, J. Hay, S. Veldhuizen, B.E. Faught.
Trajectories of cardiorespiratory fitness in children with and without developmental coordination disorder: a longitudinal analysis.
Br J Sports Med, 45 (2011), pp. 1196-1201
[29]
Committee on Physical Activity and Physical Education in the School Environment; Food and Nutrition Board; Institute of Medicine.
Educating the student body: taking physical activity and physical education to school,

Please cite this article as: Lima RA, Bugge A, Ersbøll AK, Stodden DF, Andersen LB. The longitudinal relationship between motor competence and measures of fatness and fitness from childhood into adolescence. J Pediatr (Rio J). 2019;95:482–8.

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