Prevalence of obesity and motor performance - PH

Prevalence of obesity and motor
performance capabilities in Tyrolean
preschool children
Klaus Greier, Herbert Riechelmann &
Martin Burtscher
Wiener klinische Wochenschrift
The Central European Journal of
Medicine
ISSN 0043-5325
Volume 126
Combined 13-14
Wien Klin Wochenschr (2014)
126:409-415
DOI 10.1007/s00508-014-0553-1
1 23
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1 23
Author's personal copy
original article
Wien Klin Wochenschr (2014) 126:409–415
DOI 10.1007/s00508-014-0553-1
Prevalence of obesity and motor performance
capabilities in Tyrolean preschool children
Klaus Greier · Herbert Riechelmann · Martin Burtscher
Received: 4 January 2014 / Accepted: 13 April 2014 / Published online: 20 May 2014
© Springer-Verlag Wien 2014
Summary
Background The childrens’ world of movement has
changed dramatically during the last decades. As a consequence motor performance decreases particularly in
children affected by overweight and obesity. This study
analyses the influence of the body mass index (BMI) on
motor performance of pre-school children.
Methods In a cross-sectional study including 41 kindergartens in Tyrol (Austria), 4- to 5-year-old children
(n = 1,063) were recruited. Four BMI groups were used
according to a German BMI reference system: Group I
(anorexic/underweight), group II (normal weight),
group III (overweight) and group IV (obese). Motor performance was assessed by the use of the Karlsruhe Motorik-Screening (KMS 3–6).
Results Out of the 1,063 preschool children (550 ♂,
513 ♀) 7.6 % (n = 81) were overweight and 5.5 % (n = 58)
were obese. The results demonstrate that motor performance of under- and overweight preschool-children is
not different from children with normal BMI, but obese
children had significantly lower motor performance
(p < 0.001).
Conclusion The prevalence of overweight and obese
Tyrolean preschool children is similar to those of nonmountainous areas of Austria and Germany. The fact that
K. Greier, PhD ()
University College of Education (KPH) Stams,
Stiftshof 1, 6422 Stams, Tirol, Austria
e-mail: klaus.greier@kph-es.at
H. Riechelmann, MD
Medical University Innsbruck,
Innsbruck, Austria
M. Burtscher, MD, PhD
Department of Sport Science, Medical Section,
University Innsbruck,
Innsbruck, Austria
13
motor performance is reduced only in obese children
suggests that targeted promotion of physical activity is
urgently needed for preschool children particularly considering children with a risk to develop obesity. Besides
the efforts of parents, nursery schools are the ideal setting for intervention measures.
Keywords Obesity · Children’s health · Preschool children · Motor performance · Prevention
Adipositasprävalenz und motorische
Leistungsfähigkeit bei Tiroler Kindergartenkindern
Zusammenfassung
Grundlagen Die kindliche Bewegungswelt hat sich in
den letzten Jahrzehnten grundlegend verändert. Als
Folge nimmt die motorische Leistungsfähigkeit ab,
wobei besonders Kinder mit Übergewicht und Adipositas betroffen sind. Die vorliegende Studie untersucht den
Einfluss des Body Mass Index (BMI) auf die motorische
Leistungsfähigkeit von Kindergartenkindern.
Methodik In einer Querschnittsuntersuchung wurden aus 41 Kindergärten in Tirol (Österreich) 4- bis 5-jährige Kinder (n = 1063) rekrutiert. Anhand eines deutschen
überregionalen BMI-Referenzsystems wurden 4 BMIGruppen gebildet: Gruppe I (anorex/untergewichtig),
Gruppe II (normalgewichtig), Gruppe III (übergewichtig) und Gruppe IV (adipös). Die Beurteilung der motorischen Leistungsfähigkeit erfolgte anhand des Karlsruher
Motorik-Screenings (KMS 3- 6).
Ergebnisse Von den 1063 Kindergartenkindern
(550 ♂; 513 ♀) waren 7,6 % (n = 81) übergewichtig und
5,5 % (n = 58) adipös. Die Ergebnisse zeigen, dass unterund übergewichtige Kindergartenkinder sich nicht von
normalgewichtigen unterscheiden, adipöse Kinder aber
hochsignifikant schlechtere motorische Leistungen aufweisen (p < 0,001).
Prevalence of obesity and motor performance capabilities in Tyrolean preschool children 409
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Schlussfolgerungen Die Prävalenz von übergewichtigen und adipösen Tiroler Vorschulkindern ist durchaus
vergleichbar mit jener in Nicht-Berggebieten von Österreich und Deutschland. Das Ergebnis, dass nur adipöse
Kinder eine verminderte motorische Leistungsfähigkeit
aufweisen, legt nahe, dass einer gezielten Bewegungsförderung im Vorschulalter, unter ganz besonderer Berücksichtigung von Kindern mit Risiko zu Adipositas, zukommen sollte. Neben dem Elternhaus stellen Kindergärten
das ideale Setting für Interventionsmaßnahmen dar.
Schlüsselwörter Adipositas · Kindergesundheit · Vorschulkinder · Körperliche Leistungsfähigkeit · Prävention
Introduction
The relevance of motor performance capabilities and
physical activity for healthy development of children
and adolescents has been proven by many studies [1–3].
The motor performance capabilities are part genetically
determined, but they can also be influenced by training the basic motor skills like endurance and strength
[4]. Motor performance capabilities and physical activity influence each other and can be regarded as a major
indicator for the overall health of children and adolescents [5]. In the context of a salute-genetic understanding of health, motor performance capabilities and
physical activity are therefore regarded as important
health resources. In accordance, epidemiological studies underline the important role of motor performance
capabilities for prevention [6–9].
The children’s movement behaviour and physical
activity levels have changed substantially in almost all
industrialised nations within the last decades and are
characterised mainly by a lack of movement [10, 11]. Several studies [12–14] show that according to the guidelines
of the World Health Organisation (WHO), the majority of
children and adolescents do not have sufficient amounts
of physical activity. Besides a deficit in motor performance capabilities, a lack of movement is in most cases
accompanied by overweight [15–17]. Besides the level of
physical activity, the genetic disposition, socio–demographic factors and malnutrition play an important role
in the development of overweight and obesity [18–21].
As far as the caloric intake is concerned, studies [22]
show that this factor has not changed much in the last 2
decades, while the amount of daily physical activity has
reduced significantly [1, 11, 19]. Therefore, a lack of physical activity has to be regarded as a main risk factor for the
development of overweight and obesity. In this context
Blair [23] even says that physical inactivity is the main
threat to health in the twenty-first century.
The Childhood Obesity Report of the International
Obesity Task Force (IOTF) of the WHO was introduced in
2004 with the headline “EU childhood obesity out of control”. In this document, a rapid increase of the percentage of overweight and obese children in entire Europe
was reported and it was estimated that 14 million chil-
dren are overweight in Europe, out of which 3 million
are obese [24]. Along the same lines, the German KiGGS
study demonstrated that 15 % of the 3- to 17-year old children and adolescents were overweight and 6 % were even
obese [24, 25]. Similar results were published in recent
Austrian studies [26, 27].
The influence of the body mass index (BMI) on the
motor performance capabilities of children and adolescents was repeatedly analysed. Several studies show that
overweight and obese children and adolescents have
lower motor performance capabilities compared to their
normal-weight counterparts [1, 3, 11]. For preschool
children, this relation has rarely been focussed upon in
scientific studies [28]. Preventive measures would be
especially important at this young age since the emergence of particular risk factors can be successfully prevented in these stages of development [29].
Accordingly, the aim of this study is to analyse the correlation between motor performance capabilities and
weight status in preschool children in an alpine region
where no corresponding information has been available so far. The hypothesis that being overweight and
especially obesity is related to lower motor performance
capabilities is assumed.
Methodology
The analysis of the weight status and the motor performance capabilities in preschool children was conducted
in the federal state of Tyrol (Austria). While the relation
between the weight status and the motor performance
capabilities should not be influenced by the special geographical location of Tyrol (Alpine region; mountain area),
the prevalence of overweight and obesity might be affected.
Sample
According to the Department of Education of the federal
state of Tyrol, a total number of 18,000 children attended
454 kindergartens in the school year 2011/2012. Out of
these, 77 kindergartens are located in very outlying and
remote areas and were therefore not included in this
analysis. A random sample of n = 50 was drawn from the
remaining 377 kindergartens using the Statistical Package
for the Social Sciences (SPSS) random sample function.
Kindergartens from rural and urban areas were included
in the relation 4:3, corresponding to the Tyrolean population. Accordingly, the sample can be regarded as being
representative for Tyrolean preschool children.
The randomly selected kindergartens were contacted
and asked for participation. Nine kindergartens could
not participate for organisational reasons. Ultimately,
41 kindergartens remained in the sample, out of which
a total of 1,063 four- to five-year-old children (513 girls
and 550 boys) were recruited for testing. The testing was
approved by the competent authorities of the federal
state of Tyrol and by the management of the kinder-
410 Prevalence of obesity and motor performance capabilities in Tyrolean preschool children
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gartens. The parents of the participating children were
informed and their approval was obtained.
Standing long jump (explosive strength)
Study protocol
The motor tests were conducted between September
2011 and May 2012 during the regular opening hours
in the facilities of the kindergartens. First, the height
and the weight in sport clothing without shoes (barefoot) were measured. The height measurements were
taken using the mobile stadiometer “SECA® 213” (Seca;
Germany) with an accuracy of 0.1 cm and the body
weight was measured with the calibrated scale “GRUNDIG® 3710” (Grundig AG; Germany) with an accuracy
of 0.1 kg. Based on these data the BMI (kg/m2) was calculated in accordance to the BMI reference system by
Kronmeyer-Hauschild et al. [30]. Within this reference
system, children are regarded as being of normal weight
if their weight is between the 10th and the 90th percentile. Values below the 3rd percentile are considered as
being anorexic, those between the 3rd and the 10th percentile as underweight. If the weight is between the 90th
and the 97th percentile, the children are considered as
being overweight and values above the 97th percentile as
obese. For the analysis, the BMI values were divided into
four groups, underweight, normal weight, overweight
and obese. Because of the low number of anorexic cases
(n = 36; 3.4 %), the anorexic group has been pooled with
the underweight group.
Test implementation
The motor performance capabilities were measured
using the Karlsruhe Motor Screening (KMS) for kindergarten children [31]. According to the test instructions,
the children first completed a test run for all items in
order to familiarise themselves with the four validated
test items: stand and reach, one-legged stance, standing
long jump and side-to-side jumps.
Stand and reach (mobility)
This test serves the purpose of measuring the mobility of
the torso and the active stretching ability of the muscles
in the rear of the trunk. During this test the upper body
has to be lowered down as far as possible while keeping the legs straight. The distance between fingers and
standing surface is measured. The standing surface is the
zero point of the scale, values above the standing surface
are negative, below are positive. The values are recorded
in centimetres (cm). The score of only one attempt is
recorded.
One-legged stance (balance)
This test measures the ability to balance while standing. The number of contacts of the free leg with the floor
13
during 1 min. of standing on the other leg on a T-bar is
recorded. The score of only one attempt is recorded.
Using both legs, the child has to jump forward as far as
possible. Two attempts are granted and the best distance
is recorded. The child has to remain standing after the
jump in order to make the jump valid.
Side-to-side jumps (coordination under time
pressure)
The child has to jump with both legs at the same time
from one side of a bar on the floor to the other as fast as
possible for 15 s. The total number of successful jumps
from two valid attempts are summed up and recorded.
Data evaluation
For interval-scaled data, the mean (M) and the standard deviation (SD) are presented. The frequencies are
displayed in tables and diagrams. The sum scores of all
tests (sum of the Z-values of all four test items divided
by 4) was calculated using Z-standardisation. Hereby the
values of the test item “one-legged stance” were multiplied by −1 in order to make the results compatible with
the other three items, where high scores indicate a high
motor performance capability. The normal distribution
of the sum scores was tested using the one sample Kolmogorov-Smirnov goodness of fit test and the Levene test
was used to check for variance homogeneity. The alpha
level was set at 0.05. The statistical processing and analysis of the collected data was done with the statistical software package SPSS 18 (IBM Corporation, Armonk, NY).
Results
The mean age of the tested preschool children was
4.9 ± 0.5 years and the mean BMI 15.8 ± 1.9. According to
the used reference system [30], 7.6 % (n = 81) of the 1,063
preschool children (550 boys; 513 girls) were overweight
and 5.5 % (n = 58) obese. The boys were more often overweight and obese compared to the girls, but these differences were not significant (p > 0.05) (Table 1).
The total score (mean Z-values) of the KMS tests did
not show any significant gender differences in this study
(p > 0.4). However, the scores of the obese children are
significantly different from those of the other three BMI
groups (p < 0.001). As shown in Fig. 1, no significant differences in motor performance capabilities could be
detected between underweight, normal weight and overweight children (p > 0.05).
Looking at the results of the individual test items, it
shows that under-, normal and overweight preschool
children scored significantly higher (p < 0.05) in the items
“one-legged stance”, “side-to-side jumps” and “standing
Prevalence of obesity and motor performance capabilities in Tyrolean preschool children 411
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Table 1 Characteristics of the different BMI groups
Characteristic
Age
Gender
Height (cm)
Weight (kg)
BMI
Underweighta
Normal weight
Overweight
Obese
Total
M
4.88
4.87
4.83
4.86
4.87
SD
0.51
0.53
0.55
0.54
0.54
Male n (%)
47 (4.4)
424 (39.9)
45 (4.2)
34 (3.2)
550 (51.7)
Female n (%)
53 (4.9)
400 (37.6)
36 (3.4)
24 (2.3)
513 (48.3)
M
112.5
111.9
111.8
114.9
112.1
SD
6.1
5.4
7.4
6.9
6.2
M
16.4
19.4
22.9
28.2
19.8
SD
1.8
2.4
3.2
4.9
3.5
M
13.2
15.4
18.3
21.2
15.8
SD
0.4
0.9
0.5
2.0
1.9
Anorexic weight is pooled with underweight.
a
Fig. 1 Total scores (Z-scores) of male and female preschool
children in the four groups (obese boys and girls are significantly different from the other three groups; p < 0.001)
long jump” compared to their obese peers (Fig. 2a, b, and
d). In the mobility test “stand and reach”, no significant
differences between the weight groups could be detected
(Fig. 2c). None of the four test items showed significant
differences between the genders.
Discussion
In this study a total of 1,063 four- to five-year old children
from 41 Tyrolean kindergartens were grouped into four
weight groups according to the German reference curves
[30] and their motor performance capabilities were measured using KMS 3–6. It showed that 7.6 % of the analysed
children were overweight and 5.5 % obese. The frequency
of overweight children in Tyrol seems to be comparable
to non-mountainous areas in Austria and Germany.
Weber et al. [32] have just recently analysed more than
2,300 first graders in Augsburg (Germany) and found that
8.2 % of them were overweight and 4.9 % obese. Accordingly, assumed differences caused by the geographical
characteristics of Tyrol could not be confirmed.
The motor performance capabilities of under- and
overweight preschool children do not differ from those of
normal weight children. However, obese children show
highly significant lower motor performance capabilities.
Since it was assumed that overweight children already
have lower motor performance capabilities, this initially
formulated hypothesis can only partially be confirmed.
The presented results are also not consistent with other
studies [1, 11, 33], in which overweight children had considerably lower scores. These studies focussed mainly on
school children and adolescents. Besides, in some studies different test methods were used and overweight and
obese children were placed in one group.
It cannot be ruled out that the special geographic features of the region had an influence on the results. On
the other hand it could be assumed that a higher BMI has
a growing impact on the motor performance capabilities
with increasing age.
When looking at the individual test items of the KMS
3–6, it showed that under-, normal and even overweight
preschool children scored significantly higher in the
“one-legged stance”, the “standing long jump” and the
“side-to-side jumps” compared to the obese children.
Only the mobility test “stand and reach” did not reveal
any differences between the four test groups (p > 0.05).
Here, the obese children achieved similar results as their
normal weight peers. This goes in line with the results of
other studies also showing that overweight and obese
children did not achieve lower scores in the mobility test
“stand and reach” compared to normal weight children
[31, 34, 35]. A potential explanation for this could be the
fact that this test item requires only a minimal “dynamic”
in the movement itself.
Health-related consequences of obesity in
children
Even though, in contrast to adults, a correlation between
the BMI and potential health risks in children could only
be shown in individual cases [36], it is most likely that an
increased fat mass is related to a heightened morbidity
412 Prevalence of obesity and motor performance capabilities in Tyrolean preschool children
13
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original article
Fig. 2 Individual scores
(Z-scores; 95 % CI) for the
four test items “one-legged
stance” (a), “side-to-side
jumps” (b), “stand and
reach” (c) and “standing long
jump” (d), differentiated by
weight groups (p-values indicate significant differences
between the weight group
“obese” and the other three
groups)
risk even in early childhood [37]. According to Lobstein
and Jackson-Leach [38], type 2 diabetes, hypertension
and lipometabolic disorder are the most common consequences. The authors start from the premise that in the
European Union (EU) around 20,000 children suffer from
type 2 diabetes, 400,000 from impaired glucose tolerance
(IGT) and over one million children have cardiovascular risk factors such as hypertension and elevated blood
lipid levels. In Germany it was determined that in 15 % of
12- to 15-year-old school children at least one cardiovascular risk factor exists [39].
In the “Young Finns Study” [41] it was found that obesity in childhood promotes the development of angiopathy in adulthood. Additionally, the results show that
systemic blood pressure readings in 3- to 4-year-old children have a much higher predictive value than the readings in older childhood.
Besides physical heath-related issues, the development of overweight in early childhood can also lead to
emotional and social problems. Stigmatisation and isolation of the affected children is frequently observed. This
in turn may promote harmful behaviour like physical
inactivity and unhealthy eating habits that are in many
cases maintained in adulthood [7, 40].
These are all reasons why obesity prevention and therapeutic measures for obese preschool children should be
focussed upon and implemented already in kindergartens. It is however important to mention that successful
prevention and treatment can only be achieved if parents
support their children in regard to food, physical activity,
education and mental health.
Relevance of motor performance capabilities
As mentioned earlier, the overall energy input should
not have changed much during the last 2 decades [22],
13
while the level of physical activity has declined notably
[1, 11, 19]. This implies that physical inactivity does not
only go in hand with lower motor performance capabilities, but also constitutes a main risk factor for the development of overweight and obesity. Several studies were
able to show the positive effects of an early promotion of
physical activity on the motor performance capabilities,
the weight levels and the overall health of children [28,
42, 43, 44]. The 2-year intervention study conducted in
Berlin (Germany) with preschool children demonstrated
that the motor performance capabilities in the intervention groups could be improved significantly compared to
the control groups [29, 43]. Further, this intervention had
positive effects on the blood pressure levels.
Limitations
Even though these results were acquired from a large
and representative (for Tyrol) sample, some methodological limitations cannot be neglected. One limitation
is that the socio–economic status of the tested children
has not been assessed because this was beyond the
scope of this investigation. The main focus of the presented study has been set on associations between the
motor performance capabilities and weight status. It is
well known that overweight and physical inactivity is
influenced by socio–economic factors. Actually, migration background may represent such a factor applying
to 24.9 % of the study population with a mother tongue
other than German.
Another limitation arises from the nature of a crosssectional study. For example, we don’t know how many
obese preschool children will eventually become obese
in adulthood [45, 46]. The effects of the geographical
location of Tyrol do not necessarily have to be identical with the ones in other non-mountainous or urban
Prevalence of obesity and motor performance capabilities in Tyrolean preschool children 413
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regions, even though no clear indicators for this are available here.
Despite these limitations it has to be mentioned that
so far hardly any data are available on the motor performance capabilities in relation to the weight status of preschool children. The high relevance of early prevention
and measures can therefore be derived from the results
of this study.
Conclusion
This study shows that the motor performance capabilities of obese preschool children are less developed compared to their under-, normal and overweight peers. The
results suggest that measures to promote physical activity in preschool age should be implemented with special
attention paid to those children with a risk of developing
obesity. Since the foundation of an active lifestyle is laid
in early childhood and this can positively influence the
activity level later in life, kindergartens are the ideal setting for intervention measures besides the home and the
parents of the children.
Conflict of interest The authors declare that there are no actual or potential
conflicts of interest in relation to this article.
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