Education 3-13

International Journal of Primary, Elementary and Early Years Education

ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/rett20

Interventions targeting motor skills in pre-school-

aged children with direct or indirect parent
engagement: a systematic review and narrative
synthesis

A. Stevenson, N. Wainwright & A. Williams

To cite this article: A. Stevenson, N. Wainwright & A. Williams (2022): Interventions

targeting motor skills in pre-school-aged children with direct or indirect parent
engagement: a systematic review and narrative synthesis, Education 3-13, DOI:
10.1080/03004279.2022.2034174

To link to this article: https://doi.org/10.1080/03004279.2022.2034174

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EDUCATION 3-13
https://doi.org/10.1080/03004279.2022.2034174

Interventions targeting motor skills in pre-school-aged children

with direct or indirect parent engagement: a systematic review
and narrative synthesis
A. Stevenson , N. Wainwright and A. Williams
Institute of Management and Health, University of Wales Trinity Saint David, Carmarthen, Wales, UK

ABSTRACT ARTICLE HISTORY

Competency in fundamental movement skills (FMS) lays the foundation Received 6 December 2021
for developing more complex motor skills and supporting a physically Accepted 20 January 2022
active future. Preschoolaged children are at a crucial window of
KEYWORDS
development, so intervening with motor skill programmes increases the Motor skills; intervention;
likelihood of future physical activity (PA) participation. Parents/carers are movement programme; pre-
principal gatekeepers for children’s PA during the early years and school; parents; family
influence their motor competence. Interventions that involve parents
have shown to be effective in mediating improvements in FMS, yet to
date, no studies have reviewed types of parental engagement within
interventions in relation to motor competence outcomes. This review
aimed to evaluate the effectiveness of motor skill interventions for
preschoolers with the inclusion of a parental/home component.
Literature searches were completed in PubMed, Sports Discuss and the
Cochrane Library. Studies that implemented an intervention with direct
or indirect parental engagement and evaluated FMS as an outcome
measure were included. Seventeen studies met the inclusion criteria and
a narrative synthesis of results suggested type of parent engagement
may be associated with improvements in preschoolers’ motor skills. It
can be recommended that early years’ motor skill interventions should
include parents, ideally encouraging their active participation which
may be the most influential form of parent engagement.

Introduction
Overweight and obesity levels in pre-schoolers are alarming. In recent years approximately 38 million
children worldwide under the age of five were classified as overweight or obese (WHO 2019). Chil-
dren who are overweight or obese are inclined to show lower levels of physical activity (PA) and have
low motor competence (Cheng et al. 2016; Logan et al. 2012). Motor competence encompasses fun-
damental motor/movement skills (FMS), which include locomotor skills (LS), object control skills
(OCS) and stability. These foundational movements, such as balancing, running and catching, are
building blocks for more complex movement patterns (Bellows et al. 2013) and critical for children
to acquire in early childhood (Gallahue, Ozmun & Goodway, 2012), as without developing these skills
as a base for physical competence, it is unlikely that children will be motived or confident to be phys-
ically active as they progress through to adolescence (Lubans et al. 2010). As well as low proficiency
in FMS associated with less engagement PA in later life, it relates to reduced cognitive abilities, poor
perceived physical competence (Robinson 2011) and depressive behaviour at school age (Piek et al.

CONTACT A. Stevenson 1907431@student.uwtsd.ac.uk

© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
2 A. STEVENSON ET AL.

2010). On the positive side, higher motor competence has been shown to link with better health out-
comes, including greater cardiorespiratory fitness and a lower body max index (Veldman, Jones, and
Okely 2016).
Preschool-aged children are at a crucial window for the development of motor skills (Clark and
Metcalfe 2002) as cognitive development occurs rapidly (Ayres and Robbins 2005). According to a
recent review, interventions targeting FMS in pre-schoolers have been effective, demonstrating
large effects on OCS and moderate effects on LS (Van Capelle et al. 2017). Expert-led interventions
are most effective in mediating improvements in FMS (Wick et al. 2017), yet interventions are primar-
ily teacher-led, and some include parent education (Van Capelle et al. 2017). Veldman, Jones, and
Okely (2016) criticised that many interventions ignore the home/parental component, which is
key to ensuring important messages are shared to the home environment.
Parents influence their children through both direct and indirect actions (Hingle et al. 2010).
Direct parent involvement includes parents actively participating, which may be one of the
most advantageous forms of parental influence (Rhodes and Lim 2018) as it encourages reciprocal
reinforcement, parental role modelling and opportunities for encouragement. Although previous
FMS systematic reviews have taken parental engagement into account, these have not evaluated
ways in which parents are involved and discussed subsequent influences on motor skill outcomes.
Following a similar scope to the current review, van de Kolk et al. (2019) evaluated the effective-
ness of childcare-based interventions with direct parental involvement on weight status and
energy balance-related behaviours (EBRBs) of 2–5-year olds. They concluded that interventions
with direct parental involvement demonstrated promising effects on improving children’s
EBRBs, with most effects observed for motor skill development. This review included studies
with direct parent involvement; however, considering indirect parent involvement may also
provide useful insight. It may not always be feasible for some settings to include direct parent
involvement; therefore, programmes with indirect parental engagement were evaluated within
this review. The current review aims to provide a narrative synthesis evaluating the inclusion of
parental engagement within interventions and how this may influence motor competence out-
comes for preschool-aged children.

Methods
Literature search
Between August 2020 and September 2020, a literature search was conducted of electronic data-
bases (PubMed, Sports Discuss, Cochrane Library), which was guided by the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement (Moher et al. 2009).
The search strategy included all possible combinations of keywords from the following groups:
(1) ‘motor skill’*, ‘motor competence’, ‘motor proficiency’, ‘motor performance’, ‘motor ability’ ‘fun-
damental motor skill*’ ‘fundamental movement skill*’ or ‘motor coordination’; (2) ‘preschool child*’,
‘pre-schooler*’, ‘young child*’, ‘early childhood’, ‘early years’, or ‘early childhood’; and (3) ‘parent’,
‘famil*’, ‘parent involvement’, ‘parent engagement’ or ‘carer’. Following the keyword search,
titles and abstracts from the articles identified were screened against the review criteria. Possibly
relevant articles were downloaded for full-text evaluation. From the full-text articles selected, refer-
ence list searches (backward reference search) and a cited by reference searches (forward reference
search) were carried out. Literature reviews, systematic review and meta-analysis were also
screened as part of the literature search to identify relevant studies that included a parent or
family component. Results from the searches were collated within a bibliographic library and dupli-
cates were removed.
Eligible studies included clustered or un-clustered control trials, randomised controlled trails, pre-
and post-test designs or quasi-experimental designs where typically developing pre-school children
were assigned to an intervention or control group to improve FMS or motor skills. The preschool
 EDUCATION 3–13 3

years (3–5 years of age) are considered the ‘golden age’ of motor skill competence (Figueroa 2017),
but to account for differences globally in ages considered as preschool, the age range for studies
included in the current review is 2–6 years. The intervention could take place in a range of settings
including preschools, childcare centres, community settings or home-based and required the
inclusion of direct or indirect parental engagement. The duration of the intervention had to be at
least 4 weeks and report a motor skill outcome measure in analysis. Studies that did not measure
motor skills, despite involving parents, were not included in the current review. Intervention
studies were excluded if they were not written in English, not applying pre–post-test design or
pilot studies.

Methodological assessment
A methodological assessment tool (Altman et al. 2001) aligning with PRISMA guidelines (Van Sluijs,
McMinn, and Griffin 2007) was implemented into this review, as previously applied in existing sys-
tematic reviews within the field of motor development (Veldman, Jones, and Okely 2016). This
tool determined methodological quality using a 10-item quality assessment scale, displayed in
Table 1. Studies were regarded as high quality if they had a total score greater than 5 or if they
were a randomised control trial, then if the total score was greater than 6.

Results
Study selection
A flow diagram illustrating the study selection is displayed in Appendix 1 (Table 1). Initial literature
searching produced 7950 hits which were reduced to 168 to be screened by title and abstract.
Records were addressed for eligibility based on the inclusion criteria. Key reasons for exclusion
included the age participants, lack of reporting, no measurement of motor skills or no parent com-
ponent. Finally, 17 studies were considered in this review.

Study characteristics
Seventeen studies were included in the review. Six took place in Europe (2,5,8,10, 11 & 12), five in the
USA (1,4,6,14 & 15), two in Canada (3 &13), three in Australia (7, 9, 16) and one in China (17). Thirteen
interventions were delivered by childcare providers or pre-school teachers, five by experts and one
by parents, facilitated by experts. Eleven studies used a cluster randomised control trial design (2, 4,

Table 1. Methodological quality assessment items.

Item Description
A Key baseline characteristics are presented separately for treatment groups (age, and at least one outcome measure) and
for cluster randomised controlled trials and controlled trials, positive if baseline outcomes were statistically tested and
results of tests were provided
B Randomisation procedure clearly and explicitly described and adequately carried out (generation of allocation sequence,
allocation concealment and implementation)
C Validated measures of motor development used (validation in the same age group reported and/or cited)
D Drop out described and ≤20% for <6-month follow-up or ≤30% for ≥6-month follow-up
E Blinded outcome assessments (positive when those responsible for assessing motor development at outcome were
blinded to the group allocation of individual participants)
F Motor development assessed a minimum of 6 months after pre-test
G Intention to treat analysis for motor development outcomes(s) (participants analysed in group they were originally
allocated to, and participants not excluded from analyses because of non-compliance to treatment or because of some
missing data)
H Potential confounders accounted for in motor development analysis (e.g. baseline score, group/ cluster, age)
I Summary results for each group + treatment effect (difference between groups)+its precision (e.g. 95% CI)
J Power calculation reported, and the study was adequately powered to detect hypothesised relationships
4 A. STEVENSON ET AL.

5, 7, 9, 10, 11, 12, 13, 16), six used a quasi-experimental design (1, 3, 6, 14, 15, 17) and one a retro-
spective design (8).

Methodological quality
The methodological quality of the studies is displayed in Table 2. All studies apart from three were
rated high for methodological quality, and the three weak ratings were due to a lack of reporting,
such as failure to report blinding.

Intervention components
The intervention components with details on the parent engagement element are displayed in
Table 3 and explained further within the narrative synthesis. The level of parent engagement
was rated and categorised into low, moderate or high based on the amount and intensity of par-
ental components (see Appendix 2). A low level of parent engagement was assumed if the study
included one or a small number of indirect methods such as providing newsletters or attending
one training workshop. A moderate rating was assumed if the study included a number of
methods combined. Studies were assumed to have high parental engagement if they included
co-activity.

Synthesis of results
From the 70 studies in this review, 14 (78%) reported significant favourable FMS results for the inter-
vention group compared to the control group. A narrative synthesis of results, whilst evaluating
intervention components, revealed some trends.
Three studies included active engagement from parents in the intervention (3, 6, 9), all resulting in
significant improvements in motor skills compared to the control group. These were delivered by a
range of facilitators: parents with support from experts (6), teachers (9) and graduate experts (3). The
abovementioned studies were classed as having a high parental engagement. Four additional
studies with high parental engagement (1, 10, 15 and 17) included a range of features such as mul-
tiple parent workshops (10, 15, 17), home session-plans or tasks (1, 10, 15, 17) take-home equipment
bags (1, 15) or CDs (10). One study organised family events (17) and one trained parents to deliver
training to their peers (15). These all resulted in significantly improved motor skills compared to the
control group.
Most studies with insignificant improvements in motor skill outcomes included lower levels of
parent engagement within the intervention (2, 5, 8). Types of parent involvement in these studies
included providing tip cards or newsletters (2, 5), single-parent education sessions (2, 8) or encour-
agement of a parent information evening (5). Four other studies had lower parent engagement and
mediated improvements in gross motor skills (3, 7, 10, 16).
Seven studies classified as having moderate parental engagement (4, 11, 12, 13, 14 and 16)
resulted in significant increases in motor skills compared to the control group. Parents partook in
interactive lessons (12), participated in multiple workshops (13 and 14) or received take-home
resources (4, 11 and 13).
Three studies compared centre-based intervention group to a second intervention group with an
additional parent/home component, as well as control (1, 13 and 15). One study (15) reported
impacts were greater among children who received the combined intervention, and the other
two studies found both intervention groups were significantly different from the comparison
group, but no differences were reported between those with the parent component and those
without.
Table 2. Methodological quality assessment of included studies.
Dropout Summary
≤20% for results
<6 months Motor presented +
Key baseline follow-up or development Potential treatment
characteristics Randomisation Valid ≤30% for assessed min of Intention- confounders effect t+ Power
reported for procedure measure ≥6 months Assessor 6 months after to-treat accounted for precision calculation TOTAL
Study each group clearly described of FMS follow-up blinding pre-test analysis in analysis estimates reported SCORE
1 Altunsöz and + − + + − − + + − − 5
Goodway
(2016)
2 Bayer et al. + + − − − − + − + − 4*
(2009) (RCT)
3 Bedard et al. + − + + − − + + + − 6
(2017)
4 Bellows et al. − − + − − − − + − − 2*
(2013) (RCT)
5 Bonvin et al. + + + + + + + + + + 10
(2013) (RCT)
6 Hamilton, − + + + − − + + − − 5
Goodway, and
Haubenstricker
(1999)
7 Hardy et al. − + + + + + + + + + 9
(2010) (RCT)
8 Klein et al. (2015) + − − + − + − − − − 3*
9 Piek et al. (2013) + + + + − + + + + + 9
(RCT)
10 Puder et al. + + − + + + + + − + 8
(2011) (RCT)
11 Reilly et al. + + − + + + + + + + 9
(2006) (RCT)
12 Robinson et al. + + − + + − + + + + 8

EDUCATION 3–13
(2015) (RCT)
13 Wasenius et al. + + + − + + + + + − 8
(2018) (RCT)
14 Winter and Sass + − + − − + − + + − 5
(2011)
15 Yin et al. 2012 + − + + − − + + − − 5
16 Zask et al. (2012) + + + + − + + + + + 9
(RCT)
17 Zhou et al. (2014) + − + + − + + + + − 7

5
 6
Table 3. Intervention characteristics.
Design, Setting &
Reference Sample Intervention Groups & Childcare component Parent component Motor skill assessment Main results & Discussion points

A. STEVENSON ET AL.
Altunsöz and Quasi-experimental INT1: SKIP programme (30 mins 2x/week for 8 weeks) 24 home sessions (10–15 mins each) for 8 Test of Gross Motor SKIP & SKIP-PI were significantly better
Goodway (2016), Pre-school INT2: SKIP-PI - Same dose as INT1 + 24 home-based sessions. weeks; Family equipment bag (balls, Development-2 than the CON group in OC skills.
USA (1) INT1: 22 (48.05 Implemented by a trained motor skill expert, designed to bean bags, scarves, balloons, milk jugs, (TGMD-2) (Ulrich 2000) Inability to control the home
months ± 6.45) INT2: develop OCS through developmentally appropriate practice & LS rolled paper bats, bubble wrap and environment meant fidelity was hard
25 (49.47 ± 6.41) CON: in the warm-up. Delivered in a multi-purpose room or paper spots) & lesson plans; 1.5 h to determine. The return rate for
25(47.68 ± 7.10) playground and all pre-schoolers had their own space and workshop for parents on FMS parent game sheets was low. The
equipment. authors highlighted the need to
CON: The Control group received regular curriculum reconsider incentives for parents to
be culturally relevant.
Bayer et al. (2009), Cluster-RCT INT: TigerKids (30 mins 5x/week for 1 year) delivered by teachers Four parent newsletters; ‘TippCards’ Karlsruher Motorik- No significant advantage in the motoric
Germany (2) Kindergarten involving playful, vigorous PA games & regular consumption of providing messages on health-related Screening fur testing results obtained in the INT
64 kindergartens in fruit/vegetables and regular consumption of water in daycare. behaviour e.g. ways to encourage Kindergarten kinder group. The motoric testing
four regions Folder for teachers containing materials, modules for daily healthy eating & examples of (KMS 3–6) (Boes et al., performed in the study might have
INT: 13, CON: activities and a CD integrating regular PA into family’s 2004) been a poor surrogate marker for
CON: Maintained usual curriculum daily routine increased PA
Bedard et al. (2017), Quasi-experimental INT: Move to Learn (1 h/week for 10 weeks) led by physical literacy Active involvement of one parent of each Peabody Developmental Significant effect of group on gross
Canada (3) Community graduate students. Specific movement skills were focused on child in the direct instruction; parents Motor Scales-2nd motor raw scores overall (F = 4.67, p
INT/EXP: n = 8 (41.4 each week. Free play opportunities with access to play items and provided with handouts outlining edition (Folio & Fewell < 0.05). Significant gains in gross
months ± 6.99) equipment for gross and fine motor skills (play balls and puzzle weekly activities 2000) motor despite the relatively low dose
CON:n = 11(45.6 ± pieces). Parents/caregivers were actively involved. of the intervention (1x/week for 1 h)
7.30) CON: Control group participated after the second testing highlights the importance of parental
component.
Bellows et al. Cluster-RCT INT: Mighty Moves (15-20 mins 4x/week for 18 weeks) led by the Weekly home connection materials; PDMS–2 (Folio & Fewell The INT group demonstrated significant
(2013), USA (4) Childcare setting teacher in a classroom. Each week’s activities focused on either music CD to practice motor skills 2000) changes in gross motor skills
INT: n = 98 (53 stability, locomotor or manipulation skills which were activities along compared with the CON group
months ± 6.8) CON: n introduced by superhero characters. The intervention also
= 103 (51.5 ± 6.6) included a ‘food friends’ nutrition programme
CON: Food Friends, a 12-week nutrition programme
Bonvin et al. (2013), Cluster-RCT INT: Youp’là Bouge (9 months) – Governmentally led programme, Parent information session encouraged to Zurich Neuromotor No intervention effect on motor skills.
Switzerland (5) Childcare centres socio-ecological model: individual (children, educators & discuss programme & benefits of PA; Assessment extended Issues relating being governmentally
INT: n = 313 (3.4 years parents) & environmental (childcare, daily PA) levels. Five PA Parent flyers with intervention info & validated for 3–5 led - no demands regarding daily PA
± 0.6) CON: n = 335 workshops for educators delivered by sports scientists. Every 2 year old children time or structured PA curriculum, no
(3.3 ± 0.6) months, educators exchanged ideas. Childcare centres received (Kakebeeke et al., 2013) info about organisation of a parental
a grant to improve the environment. info session obtained.
CON: Received regular pre-school programme
Hamilton, Quasi-experimental INT: Parent-Assisted programme (45 mins x 2/week for 8 weeks), Two parent meetings before study; TGMD TGMD (Ulrich, 1985) Gains in OC total score from pre-test to
Goodway, and Pre-school children delivered by parents/facilitated by experts. Lessons included a performance criteria presented to post-test by the INT group, the CON
Haubenstricker INT: n = 15 (3.9 yrs±.2) minimum of 2 of the 5 OCS. 15-minute parent instruction parents with feedback; parents group showed no or little change in
(1999), USA (6) CON:n = 12 (4.0± .3) sessions before sessions with experts. provided with key teaching points prior total OC score. Change was evident in
CON: Regular activity programme including songs with parents to sessions all 5 OC skills tested in the study in
the INT group.
Hardy et al. (2010), Cluster RCT INT: Munch and Move (1-day professional development) Childcare providers spoke directly to TMGD-2 (Ulrich 2000) At follow-up, LS, OCS and total FMS
Austrailia (7) Pre-school Government initiative -Grant for pre-schools to support staff parents; letters home and messages on significantly improved in the INT
INT: n = 263 (4.4 training, purchase PA equipment and for health professionals to notice board group compared to the CON group.
years ± 0.5) CON: n = support programme delivery. Intervention promoted healthy The INT group showed a larger (non-
167 (4.5 ± 0.3) eating, active play and FMS. The programme manual included a significant) improvement across a

(Continued)
Table 3. Continued.
Design, Setting &
Reference Sample Intervention Groups & Childcare component Parent component Motor skill assessment Main results & Discussion points
range of games related to healthy eating and FMS activities range of skills compared to the CON
designed to develop LS, OCS and stability skills. group. Higher proportion of children
CON: Received health info on other topics (road safety) in the INT group improved in 2 or
more OCS.
Klein et al. (2015), Retrospectively INT1: The Kindergarten Mobile (1 info session 90–120 mins) for KIMO&NF: Single info session on healthy KiMo-test (Klein et al. Outcomes were inconsistent for motor
Germany (8) Pre-school parents and educators - messages for healthy lifestyle, FMS, PA & lifestyle; fitness passes with test results 2012) performance. All groups improved in
N = 1436 (4.7 years ± booklets with child’s info all test items as a result of natural
0.9) INT1: 16 INT2: Ball & Pear (60mins x1day/week for 6 months) Health development, but no intervention
preschools, INT2: 2, promotion including movement, body perception & nutrition. was superior to the CON group.
INT3: 11, CON: 11 Hand puppets lead the programme More intensive and targeted activity
INT3: Nursery Fit 1 info session for parents and educators & is necessary to effect motor abilities.
60mins x1day/week for 6 months of PE in groups of 10–15
children. No structured guidelines defined.
CON: Participated in usual curriculum for 6 months.
Piek et al. (2013), Cluster RCT INT: The Animal Fun program (30 mins x4/week for 10 weeks), Parents participated with children in the Bruininks-Oseretsky Test Programme significantly improved
Australia (9) Children aged 4–6 delivered by teachers. Programme involved imitating animal intervention (their involvement was of Motor Proficiency– 2 motor performance, although motor
from low SE area movements to develop motor and social skills. Children were not described in detail in the paper) (BOT-2SF) (Bruininks ability of the INT group was
N = 511 (5.42 yrs ± challenged appropriately depending on their ability. Teachers 2005) significantly poorer than that of the
3.58 mnths) INT: 6 participated in a 1-day training course prior to programme CON group at baseline (although
schools, CON: 6 implementation matched for SES/ school)
CON: Normal curriculum
Puder et al. (2011), Cluster RCT INT: Ballabeina intervention (45 mins x 4/week for 1 school year), 3 info evenings promoting PA, healthy Motor agility (obstacle Significant improvement in motor
Switzerland (10) Pre-school children- delivered by teacher & 1x/week by the health promoters. food, limiting TV and importance of course) and dynamic agility (time to complete obstacle
area with high Activities based around themes (superheroes) Intervention sleep; Parent brochures containing key balance (balance course) in the INT group compared to
proportion of migrants intervened at individual (children, teachers, and parents) and messages; Bi-weekly take-home PA or beam) the CON group (mean difference:
N = 625 (326 boys); environmental (school curriculum and built environment of nutrition card with exercises to be done −0.54, p = 0.004). No significant
INT: n = 167 (5.2 years class) levels & included workshops, lessons, home activities & at home; CD for the PA cards. difference in dynamic or static
± 0.6), CON: n = 159 adaption of environment as well as nutritional component balance between the INT and CON
(5.2 ± 0.6) CON: Continued regular school curriculum group.
Reilly et al. (2006), Cluster RCT INT: Movement and Activity Glasgow intervention in children Family resource pack (£16) including Movement Assessment The INT group had significantly higher
Scotland (11) Childcare/Nursery (MAGIC) (30 mins x3/week for 24 weeks). Intervention group guidance on linking physical play at Battery performance in movement skills than
N = 545, INT: n = 268 received PA program (focusing on FMS) plus home-based health nursery and home; Two parent health the CON group at 6-month follow-up
(4.2 years ± 0.3),CON: education to increase PA through play and reducing sedentary education leaflets; posters on
n = 277 (4.1 ± 0.3) behaviour. Sessions were delivered by nursery staff who had increasing PA displayed in nursery
attended 3 training sessions. setting

EDUCATION 3–13
CON: Usual curriculum
Roth et al. (2015), Cluster RCT INT: The Prevention through Activity in Kindergarten Trial PA homework cards once/twice a week; Obstacle course The INT group showed significantly
Germany (12) Pre-school children (PAKT) (30 mins daily for 11 months). Intervention targeted Three 3 interactive parent lectures with higher motor skill performance than
INT: 21 preschools children, parents and pre-school teachers. Children received a info on healthy development and the CON group –significant
CON: 20 preschools daily 30-minute PA lesson delivered by preschool teachers, promotion of motor skills improvements in explosive leg
N = 664 children developing motor skills through games and tasks. Teachers strength, jumping coordination and
(4.7years ± 0.6 yrs) attended 2 workshops and were supervised at least once every static balance; no significant
8weeks. differences in agility dynamic balance
CON: Continued routine schedule or throwing. Improvements sustained
at 2-month follow-up

7
(Continued)
 8
Table 3. Continued.
Design, Setting &
Reference Sample Intervention Groups & Childcare component Parent component Motor skill assessment Main results & Discussion points

A. STEVENSON ET AL.
Wasenius et al. Cluster RCT INT1: Activity Begins in Childhood (ABC) Childcare Group Two online training webinars for parents; TGMD-2 (Ulrich 2000) Raw LS scores increased significantly in
(2018), Canada Childcare centres INT2: ABC Childcare + Home Group. (6 months) Both INT1&2 Parents/ received ABC programme both the CC group and the CC +
(13) INT:12, CON: 6 2 × 3hr workshops for childcare providers to motivate and training manual; bi-weekly postcards HOME compared to the CON group. A
N = 215 (3.6 ± 0.5 yrs) increase PA. 60 min/day PA programme including FMS training outlining fun physical activities short-term follow-up showed a
Retention: 34.4% and MusiGo preschool program (17% creative play, 33% OCS & significant difference in LS between
50% LS). Bi-monthly sessions for preschool staff with goal both the INT groups and the CON
setting, planning and feedback. group. No significant differences
CON: Continued with regular curriculum between INT and CON groups on OC
skills.
Winter and Sass Quasi-experimental INT: Health & Ready to Learn (Add duration) School readiness & Monthly group training sessions to Brigance Diagnostic The INT group experienced significantly
(2011), USA (14) 4 pre-schools – High obesity prevention strategies with a multi-level approach practise family activities; alignment of Inventory of Early more growth from pre-test to post-
poverty (ecological theory) for children, parents & teachers. Teachers and curriculum across home and pre-school Development - 2 test in gross motor skills than the
neighbourhood parents were trained to implement activities targeting gross contexts (Brigance 2008). CON group on the mon-locomotor
N = 405 (3–5 years); motor skills and encourage movement. Equipment, music, and LS, despite starting behind on
INT:2 pre-schools, materials, and guidance were provided to facilitate participation initial motor competence.
CON:2 pre-schools in fun, play-based PA.
CON: Followed standard curriculum
Yin et al. (2012), Quasi experimental INT1: Miranos! (30-45 min x5/week for 18 weeks) Employed 14 newsletters about healthy habits; 7 Learning Achievement Significant difference between the INT
USA (15) Childcare centres theories of early childhood development and a systems parents trained (10-hours) as peer Profile Version 3 (LAP- and CON group in gross motor
Sample- INT1: n = 179 approach to modify eating and PA behaviours. Age-appropriate educators & delivered 6 poster sessions 3) development at short-term follow-
(4.1years ± 0.6) INT2: gross motor programme delivered by childcare staff with on PA; at each session parents received up. Impacts greater among children
n = 80 (4.2 ± 0.5) CON: outdoor play including motor skills & dance instruction. a take-home bag including a storybook, in combined intervention. The
n = 97 (4.1 ± 0.5) Characters used for PA & healthy eating. family activities and a developmentally authors speculated that home-based
INT2: Miranos! (centre & home based) – Same intervention with appropriate interactive game intervention contributed to increased
additional take-home activities, parent education and family PA & success likely due to increased
support for healthy eating and PA parental knowledge in health and
CON: regular schedule, including unstructured free play 5/week obesity prevention
Zask et al. (2012), Cluster RCT INT: The Tooty Fruity Vegie (25-30 mins x2/week for 10 months) Workshop for parents on limiting TGMD-2 (Ulrich 2000) Significant improvements of FMS in the
Austrailia (16) Pre-schools 3–6 years FMS lessons 2/week, delivered by pre-school teachers. Grant for sedentary time, promoting PA and FMS; INT group compared the to the CON
INT1: 18 preschools, equipment & playground review. Programme was based on The monthly newsletter group. Significant differences
CON: 13 preschool Health Belief Model and the Competence Motivational Theory between gender; girls improved
(50.5months ± 6.7) CON: Regular curriculum more than boys. This study showed
good sustainability of the acquired
motor competence
Zhou et al. (2014), Quasi experimental INT: Intervention (12 months) - 30 mins morning & afternoon Monthly parent seminars on physical Battery test: Chinese Significant difference between the INT
China (17) Childcare centres outdoor play for 3-year olds & extra 30mins for 4-5 year olds. development, gross motor skills, family National Measurement and CON group in 20 m agility run,
1 int. centre 1 con. 10 min daily exercise routine delivered by teachers. Intervention PA & nutrition; newsletters with tips on Standards on People’s broad jump, tennis ball throw, sit-
Centre, N = 387 4.40 based on socio-ecological model, competence & motivation developing healthy habits; handbook & Physical Fitness inc and-reach, balance beam walk, 20 m
± 0.78 yrs. theories. Teachers attended 20-hour training period & centres website with updates on child’s fitness; Motor crawl and 30 m sprint.
received developmentally appropriate play equipment, individualised PA feedback; family
drawings of motor skills on walls & skipping markings. Healthy events e.g. making play equipment
eating component was included.
CON: regular curriculum - teachers implemented outdoor play
activities as normal
 EDUCATION 3–13 9

Discussion
This review reveals useful trends of motor skill competence following interventions for pre-school
aged children with the inclusion of a parental component. Evaluation should be interpreted cau-
tiously with findings based on a narrative synthesis.
Studies incorporating child and parent co-activity documented positive outcomes in motor com-
petence. The oldest study in this review incorporated parent-assisted delivery (6), which established
that parents can be effective in instructing children’s motor skill development with support from pro-
fessional mentors, which may be a nonthreatening parental engagement approach. Other studies
also encouraged children and parents to participate in the intervention, practicing FMS (3 and 9)
or attending family events like sports days (17). These studies resulted in significant improvements
in motor skills, suggesting that children participating alongside parents may contribute to enhancing
motor competence. With this type of parent involvement, reinforcement and parental role modelling
is able to occur (Watchman and Spencer-Cavaliere 2017) and underpinned by social cognitive theory,
children are able to learn by observing their parents’ behaviours (Bandura 1986). This postulates that
direct parent involvement may be one of the most valuable forms of parental influence (Rhodes and
Lim 2018) for pre-schoolers. Similarly, a recent review reported that actively involving parents
through participatory designs had stronger likelihood to influence children’s energy balance-
related behaviours including motor skills (van de Kolk et al. 2019). Including parents may promote
skill learning to continue outside an intervention, which could compensate if there was a smaller
intervention dose. Bedard et al. (2017) suggested running one session per week with parents may
confer similar skill gains to a higher-dose programme. This may suit parents’ preferences, as accord-
ing to Spoth and Redmond (2000), parents may prefer shorter programmes due to time demands.
Studies that incorporated moderate parent involvement also resulted in significant increases in
motor skills. A factor notably linked to these positive outcomes was the inclusion of developmentally
appropriate equipment. The MAGIC intervention (11), which provided parents with resource pack
worth £16 of appropriate equipment, lead to the intervention group having significantly higher per-
formance in movement skills compared to the control group at six-month follow up. This postulates
that providing equipment or play materials may support sustained FMS competence. van de Kolk
et al. (2019) similarly reported large effects seen on motor skill development in interventions with
parental involvement and provision of equipment. Other studies that incorporated take-home
equipment or session plans (1 and 15) lead to significant improvements in motor skills compared
to the control group, suggesting that incorporating take-home equipment or activities may be a
key intervention component, with its influence on the home environment (Ferreira et al. 2018). Evi-
dence from a longitudinal study supports this as Barnett et al. (2019) discovered that engagement in
daily toy use for 3.5-year olds was associated with OCS at 5-year olds. Similarly, Zeng et al. (2019)
reported that PA equipment and play spaces in the home are positively related with locomotor skills.
Developmentally appropriate equipment was recognised as a common feature of successful
interventions resulting in significant increases in gross motor skills, particularly where the inclusion
of parental engagement was lower. One study (4) sent a CD home rather than equipment, but within
the teacher-led programme equipment was incorporated by including activity scarves, balls, bean
bags and ropes. This appropriate equipment may have contributed to the significant increases in
motor skills arguably more than the parent component which was relatively low. Likewise, Winter
and Sass (2011) (14) provided equipment to facilitate children’s participation in fun, play-based phys-
ical activities and the intervention group experienced significantly more improvement in gross
motor skills from pre-test to post-test compared to the control group. Similarly, Puder (10) documen-
ted provision of equipment in the childcare setting including balls and skipping ropes. They
implemented weekly fun take-home cards (PA and nutrition focused) and families received a CD
to match the PA cards. This home component along with an interactive information session for
parents contributed to significant improvements in children’s motor agility through an obstacle
course when compared to the control group (10). This review identifies take-home CDs as a
10 A. STEVENSON ET AL.

popular resource to indirectly encourage family involvement and possibly motivate children to be
physically active in the home environment, which, in turn, may support motor development.
Another benefit is that these provide a minimum length of time to spend doing the activity.
Lower methods of parent engagement such as providing flyers or tip cards may be ineffective in
influencing motor skills, due to these studies that show no favourable effects from the intervention
group. Klein (8), who reported no significant outcomes for motor performance, incorporated one
parent information session. Rhodes and Lim (2018) suggested that there may be limited benefits
of educational interventions due to a ceiling effect to what parents know as being healthy. Other
studies, despite having low parent engagement, implemented multi-component interventions
with the inclusion of a nutritional element (7 and 16) and documented promising effects on
motor skills.
Only three studies within this review compared intervention groups to a separate a home com-
ponent group (1, 13, 15); therefore, analyses of parental influence alone were somewhat limited.
One study (15) found that impacts were greater among children receiving the home-based com-
ponent, supporting the notion that involving parents directly may enhance their knowledge and
skills, which would, in turn, influence their children (Veldman, Jones, and Okely 2016). On the con-
trary, the two other studies reported that children within the parent engagement group did not
improve motor skills significantly more than those who did not experience the home component
(1, 13). This reveals that in this case, regardless of parental engagement, if high-quality structured
motor skill intervention is provided, children are likely to gain significant motor skill improve-
ments. Difficulty in controlling the home environment and inability to observe families at home
may be limiting. The SKIP-PI intervention (1) was classed as having high parent engagement,
yet there was low reporting of completion of home activities. Therefore without the ability to
observe activities at home, it can be difficult to monitor if parents implement session plans effec-
tively. Low implementation of home activities may be down to the lack of familiarisation of activi-
ties and without experiencing demonstrations of appropriate activities, parents may lack in
confidence or knowledge to implement them. In support of the evaluation that parent familiaris-
ation of activities may benefit home engagement, Bedard (3) reported that the rate of at-home
practice for movement activities was around 50%, implying that activities were practised for
roughly half of the days not spent in the programme. Given that parents actively participated
in this intervention, it can be assumed they were familiar with the movement activities and, there-
fore, perhaps more confident to practise at home. As well as monitoring activities, providing cul-
turally relevant incentives are important to encourage at home participation, including
developmentally appropriate equipment and CDs which are engaging and provide a time frame
to participate in the activity.

Limitations
This review incorporated a broad literature search on multiple databases, ensuring suitable studies
were extracted, yet limitations should be noted. The intervention characteristics varied across the
studies with inconsistencies in the duration and frequency of activities. The subjective rating of par-
ental engagement in this review should be considered cautiously as the intensity or quality of parent
workshops was not reported. Another limitation to consider is that the interventions measured
motor competence with a range of tools, preventing the ability to conduct a meta-analysis.
Researchers have formerly questioned the interchangeable use of motor assessments (Stodden
et al. 2008) and to date, no standardised motor test is used for children under three years old,
thus making it challenging to compare intervention effectiveness. Participants were not always ran-
domly assigned to intervention or control groups, which may have resulted in imbalanced baseline
characteristics. A lack of assessor blinding was reported for certain studies, which may have led to
biased results given that FMS measures are often subjective.
 EDUCATION 3–13 11

Conclusion
Findings indicate that most interventions with parental engagement are effective in improving
motor competence, and this review provides useful insight into how future interventions could
best include parents. Ideally, to encourage parent engagement and translate knowledge into prac-
tice, interventions should aim to include active participation from parents, which may confer similar
results to a higher dose programme. This would promote reciprocal reinforcement, parental role
modelling and opportunities for encouragement. Some forms of parental engagement may be
insufficient in mediating improvements in children’s motor skills, such as parent education alone
and indirect methods such as newsletters. Findings from this review highlight the value of develop-
mentally appropriate take-home equipment as an incentive for family participation in PA at home,
which would subsequently influence motor competence. As well as take-home equipment, CDs or
musical incentives may be another useful incentive to encourage increased participation and thus
increase the dose and effects of an intervention. It is important to note that session plans for
parents to deliver at home may be unrealistic if parents are unfamiliar with the activities. Involving
parents within interventions to enhance motor skills is important given the influence motor compe-
tence has on children’s likelihood to be physically active as they progress through childhood to ado-
lescence and adulthood (Stodden et al. 2008; Robinson et al. 2015; Hulteen et al. 2018).
Key messages

. Interventions targeting motor skills in pre-schoolers should aim to include active participation
from parents
. Take-home equipment and activities may incentivise participation
. Parent education alone may not be sufficient in mediating improvements in children’s motor skills
. Take-home session plans or game ideas may be unrealistic if parents are unfamiliar with the
activities
. Studies should consider how they report and monitor home engagement
. Further research comparing interventions with and without parental involvement is necessary

Disclosure statement
No potential conflict of interest was reported by the author(s).

ORCID
A. Stevenson http://orcid.org/0000-0001-5214-0812

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14 A. STEVENSON ET AL.

Appendix 1.

Appendix 2. Level of parent engagement and corresponding studies with

components

High 1 – take-home bag and sessions plans, Moderate 4 – newsletters, home session Low 2 – newsletters
workshop tasks and a take- home CD 5 – single-parent
3 – direct active parent involvement 11 – newsletters, workshop,
with children noticeboards, take-home newsletter
6 – direct active parent-led intervention activity equipment 7 – newsletters
with support from mentors and multiple 12 – multiple parent and noticeboard
parent workshops workshops, home session 8 – single-parent
9 – direct active parent involvement tasks workshop
with children –limited reporting of 13 – multiple parent
parent involvement workshops, newsletters and
10 – multiple parent workshops, home session tasks
newsletters, home tasks and a take- 14 – multiple parent
home CD to incentivise home activity workshops and
15 – multiple parent workshops, parent noticeboards/staff sharing
peer training, information leaflets, home 16 – multiple parent
tasks and take-home activity equipment workshops and newsletters
17 – multiple parent workshops,
newsletters, home tasks and organised
family events