The Animal Fun Program to Support the Motor Development of the Italian Pre-schoolers: a Case-Control Study
Condition: Motor Activity
Study type: Interventional

Summary: 
      The present literature supports the importance of the motor activity since the early stages
      of the human development. The children with poor motor skills are at greater risk for
      psychosocial, internalizing, and metabolic diseases. In Italy data about obesity and
      inactivity are increasing, anyway there is lack of motor program for pre-schoolers. The
      movement program Animal Fun seems to be a valid tool to support these children. The aim of
      this study is to verify the feasibility of using Animal Fun with Italian pre-schoolers.

      119 preschool children (3-6 years old) from 3 Italian kindergartens were included in this
      study. The schools were randomly allocated to intervention and control group. Movement
      Assessment Battery for Children - 2 (MABC-2) was administered to all the children at the
      baseline and at one-month follow-up. During this month, the schools assigned to the control
      group followed the normal curriculum; the schools assigned to the Animal Fun group, followed
      the Animal Fun activity (thirty minutes, thrice a week).

      The investigators expect that the Animal Fun program demonstrates valid and feasible even in
      the Italian context, where there is lack of movement program supporting the development of
      the pre-school children.
    

Detailed description: 
      Rationale and Background:

      Motor skills and physical activity are strongly related to the cognitive, physical, social
      and psychological development of children. They are also crucial in the prevention of
      cardiovascular or metabolic diseases, such as obesity or diabetes. There is growing evidence
      indicating that children with poor motor coordination may be at significant risk for
      psychosocial and internalizing problems. Other research has found significant levels of
      anxiety and depression even in 4-5-years-old-children.

      Due to fear of failure, or of peer bullying, children with motor difficulties often limit
      their opportunity to practice motor activities, thus creating a vicious cycle. In this
      continuous negative loop, the child has low motor competency, develops low fitness training
      and tends towards hypo-activity. In contrast, if children are confident with their motor
      skills, they are more likely to participate in activities such as sports or dancing.
      Literature also relates the motor ability of preschool children to their scholastic
      adaptation and to the social adjustment in the first year of school.

      Preschool is an essential period in a child's life because Fundamental Movement Skills are
      developing at this stage, for both gross and fine motor tasks.

      Some investigators have demonstrated that most pre-schoolers don't practice the recommended
      amount of daily physical activity. Unfortunately, there is a lack of movement programs to
      engage pre-school children in motor activities. In 2010, the Curtin University developed the
      "Animal Fun" program. This program was designed to provide developmentally appropriate
      activities that would be fun and engaging for all children aged 3-6 years whilst targeting
      specific areas of development. They created a protocol, which will benefit all children in
      the group - those with and without motor difficulties. By referring to all the members of a
      class, Animal Fun avoids the stigma associated with "special programs". This is an ecological
      program for use in schools during the ordinary activities. Animal Fun is an imaginative
      program of movement, in which the children imitate animals' movements. It is flexible and
      doesn't provide a rigid structure to follow, but it adapts to children's interests and
      abilities. Evidence demonstrates, that Animal Fun supports the development of overall motor
      ability, particularly throwing and balance skills, and significantly improves social skills
      in young children.

      In Italy there is a lack of motor programs for pre-schooler children. Furthermore, children
      with poor motor skills are not recognized, therefore no specific support is provided. The
      need to identify an inclusive and flexible motor program has led us to Animal Fun.
      Considering the socio-cultural differences between Western Australia and Italy, the purpose
      of this study is to verify the feasibility of the Animal Fun program for Italian
      pre-schoolers. Study goals and objectives:

      In Italy there is lack of motor program for pre-schoolers, like Animal Fun. The first aim of
      this study is understanding the feasibility of this activity in the Italian kindergartens.
      Second, this study would understand the validity of the results of one month of Animal Fun
      practice. Using the gold standard assessment for motor skills in children, Movement
      Assessment Battery for Children - 2 (MABC-2), the main objective is to verify the motor
      improvements in children who practiced Animal Fun, compared to a control group. This
      assessment provides score about the manual dexterity, the balance and the aiming and catching
      skills. A sum of these scores provides a total score about the motor skills, in general.
      Through this test, understanding the motor competences of the pre-schoolers is affordable.

      Study design:

      This study is a longitudinal randomized controlled trial, and it is participants' blinded.

      It has been approved from the Ethics Committee of the University of Trieste. All methods were
      performed in accordance with the relevant guidelines and regulations, especially the Helsinki
      Declaration.

      As first, kindergartens' directors gave the consent to participate in the study.

      3 Kindergartens of the province of Trieste have been recruited and randomly allocated to
      Animal Fun intervention (1), and control group (2). From the three schools, we recruited 119
      pre-schoolers. The parents previously read and signed the written informed consent, to let
      the child participating.

      Inclusion criteria: written informed consent, attending one of the three involved
      kindergartens, 3-6 years old.

      Exclusion criteria: not-typically developing children and children with specific sickness.

      The duration of the study is two months.

      Methodology:

      As first, all the parents informed the investigators about the specific age of the child, the
      hand preference, and the presence of such a deficit or disease. These data were necessary to
      set up the assessment for each child. In fact, some administration-differences exist,
      especially between ages.

      Intervention group: baseline assessment with MABC-2; Animal Fun activity with a certified
      trainer (physiotherapist) for one month, three times a week, for 30 minutes; one-month
      follow-up assessment with MABC-2.

      Control group: baseline assessment with MABC-2; normal curricular activity at school with the
      teachers; one-month follow-up assessment with MABC-2

      Animal Fun activity was carried out following all the instructions given by the authors in
      the published book. This program permits the operators to propose different activities, by
      following the needing of the children. The proposed activities are entirely described in the
      nine modules of this tool.

      Before the assessment, the investigators decided to use 30 motor activities (on 97 available)
      with the intervention group. As the name of this program suggests, all the activities involve
      an animal, and ask the children to move like this animal, in a proper, correct and supervised
      way.

      After the assessment, considering the mean-scores of the children and their percentiles, the
      investigators decided to focus especially on the activities for improving the balance, and
      the aiming and catching skills. In fact, the children scored lower in these activities then
      in the manual dexterity test. For this, most of the activities of the first modules of Animal
      Fun have been proposed, which focus on the balance on two/one foot, on the locomotion, on the
      balance during a throw, on the aim. The animals involved were, for instance, the flamingo,
      the elephant, the dog, the monkey, and more.

      To the teachers of the control group, the investigators gave no additional information about
      what to do during the curricular activities, in order no to create a bias. Even the teachers
      of this group were blinded about the study.

      Safety considerations:

      In this study, the safety of the participants was guarantee. All the activities of the
      intervention group were coordinated and managed by a certified trainer, who could control the
      safety of the children during Animal Fun. Every possibile accident during the motor activity
      was considered as normal accident during the kindergarten time, and consequently managed by
      the teachers. The parents were previously informed about this issue, in the written informed
      consent.

      Follow-up:

      After the second assessment with the MABC- 2 at one-month follow-up, the participants are
      followed no more from the researchers of the present study.

      Data management and statistical analysis:

      Analysis was conducted in R (R Core Team, 2017) and graphs were produced using the package
      Rcmdr and its plug-ins.

      Normality of the variables was assessed through Shapiro-Wilk test. Intervention and control
      groups were compared at the baseline through Fisher test for the qualitative variables, and
      through the t-test for the quantitative ones. The time Δt was created to define the
      difference between the final and the basal scores. The two groups were compared considering
      Δt through the Mann-Whitney test. Kaplan-Meier estimate of the median, and 95% confidence
      interval were reported for each variable at Δt.

      Expected outcomes of the study:

      The outcomes of this study could be very significant considering the possibility of
      introducing Animal Fun in the Italian kindergartens, as curricular motor activity. The impact
      of this program of movement on the quality of the life of the pre-schoolers can be huge.
      Furthermore, giving the possibility to these children to move, and learn, can also give a
      benefit considering the prevention of metabolic, cardio-vascular, postural and psycho-social
      diseases.

      This project didn't received any fund, budget or sponsor's support.
    

Intervention name(s): Animal Fun Program
Intervention type(s): Other
Intervention description(s): This program permits the operators to propose different activities, by following the needing of the children. As the name of this program suggests, all the activities involve an animal description, and ask the children to move like this animal, in a proper, correct and supervised way.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Prevention