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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 1  |  Issue : 1  |  Page : 11-16

Effect of agility training exercise on motor proficiency and anthropometry in 6–10-year-old children with obesity


1 Department of Paediatric Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, Karnataka, India
2 Department of Community Based Rehabilitation, KAHER Institute of Physiotherapy, Belagavi, Karnataka, India

Date of Submission11-Nov-2018
Date of Acceptance04-Apr-2019
Date of Web Publication3-Jul-2019

Correspondence Address:
Mr. Subhadip Bera
Department of Pediatric Physiotherapy, KAHER Institute of Physiotherapy, Belagavi - 590 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijptr.ijptr_13_19

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  Abstract 


Background: Increased body weight, termed as Obesity, has emerged as one of the major problems in children in recent times. These children are also prone to have lower physical activity/ physical fitness levels. They are also known to have poor motor proficiency during development as well as later life if obesity continues. Early intervention is necessary to promote healthy life style & improve fitness. This study was, therefore, undertaken to determine the effect of agility training exercise on motor proficiency & anthropometry in 6 to 10 year old obese school children.
Materials and Methods: Twenty children with BMI ≥25 as per Asian criteria were recruited for this pre-post experimental study from randomly selected schools. Demographic profile of the children was collected & an assessment of their skin fold thickness (triceps, abdomen & thigh), lower extremity strength (quadriceps, hamstrings, hip extensors, hip abductors and dorsiflexors), agility (modified T test) and motor proficiency (Test of Gross Motor Development-3) was performed prior to & at the end of 2nd and 4th week of training. Agility training exercises were administered to all children three times a week for 4 weeks.
Results: Statistically significant changes from pre to post 4 weeks intervention were noted in most of the outcome measures, most notably motor proficiency (both locomotor & object control components; P = 0.0001), body weight (P = 0.0004), triceps skin fold thickness (P = 0.0033), strength of hip extensors (P = 0.0002) and agility (P = 0.0003).
Conclusion: A school based 4 week agility training program of low to moderate intensity (contextual interference) has shown to be effective in improving motor proficiency & also altering anthropometric parameters in obese children aged 6-10 years.

Keywords: Agility, Anthropometry, Childhood obesity, Gross motor coordination, Physical activity


How to cite this article:
Bera S, Dharmayat S. Effect of agility training exercise on motor proficiency and anthropometry in 6–10-year-old children with obesity. Indian J Phys Ther Res 2019;1:11-6

How to cite this URL:
Bera S, Dharmayat S. Effect of agility training exercise on motor proficiency and anthropometry in 6–10-year-old children with obesity. Indian J Phys Ther Res [serial online] 2019 [cited 2019 Jul 20];1:11-6. Available from: http://www.ijptr.org/text.asp?2019/1/1/11/261988




  Introduction Top


Obesity has emerged as a major health problem worldwide with it being the most neglected public health disease among developed and developing countries. Recently, it has been defined by the WHO as a noncontagious disease and termed as the “New World Syndrome.”[1] Indian prevalence of obesity ranges from 1% to 12.9% with higher prevalence in urban than in rural areas.[2],[3],[4],[5] The main cause of increased weight, as per the WHO, is an energy mismatch between the consumed and expended calories and a decrease in physical activity due to increasing urbanization and also due to lack of or inadequate sleep and increased consumption of aerated/carbonated drinks which are high in sugar content.[6],[7],[8],[9] Gross motor skills (GMS) or motor proficiency, generally termed as fundamental movement skills (FMS), are the basic precursor movement patterns of the more specialized, complex skills in organized or nonorganized sports, games, recreational activities or even in structured or nonstructured physical activity.[10]

A child with well-developed motor skills is more likely to be engaged with high level of physical activity in comparison to a child with poorly developed motor skills.[11] Several longitudinal analyses of gross motor coordination among overweight and obese children have reported that the weight status of a child negatively influenced the gross motor coordination,[12] with obese children having lower levels of fundamental movement skills and motor coordination such as speed, agility, fine, and gross motor skills as compared to their healthy weight peers.[13]

Currently recommended interventions include modifications of eating habits, increase in physical activity, and addressing psychosocial issues.[14] Structured aerobic exercise programs are frequently organized for obese children, but the compliance to such programs is often poor because of the obese children's lack of confidence and fear of failures.[15],[16] Nowadays, physical therapy programs have been introduced for obese children at school or community level which help in altering the quality of life of these children and also affect the physical and emotional status.[17] School-based intervention programs might be feasible and may be the ideal location for the prevention of obesity in children; however, they might not be sufficiently intense to affect both the school and family environment.[18],[19] A review done on the efficacy of an exercise intervention on improving FMS and motor coordination in children and adolescents who are overweight and obese suggested that exercise or physical activity interventions are effective in skill improvement, more focused on FMS, and motor control (MC) activities that may help to break the cycle of childhood obesity.[20]

There is a scarcity of literature to show the effect of an agility training program on motor proficiency in Indian obese children. Therefore, this study was undertaken to study the effects of agility training on anthropometry and motor proficiency in 6–10 years old school-going obese children.


  Materials and Methods Top


Participants

Twenty obese children, body mass index (BMI) ≥25 (Asian criteria),[21] from various schools using a convenience sampling method were enrolled for this study. Children with known physical disabilities, any diagnosed cardiac conditions, any recent musculoskeletal injury in the past 6 months, and any known neurological condition affecting lower extremity were excluded from the study.

Before the commencement of the study, the Institutional Ethical Committee approved the protocol and the study was carried out accordingly. Following this, permission was obtained from the school authorities selected by a computer-generated random number table. Assent was obtained from the parents of the children fulfilling the inclusion criteria.

Outcome measures

Test of gross motor development-3

It is a norm-referenced measure of common GMS that develop early in life. Test of gross motor development-3 is composed of two subtests for gross motor development, namely locomotor and object control, of which locomotor has six skills and object control has seven skills that assess different aspects of gross motor development. It was used to test the motor skills of all the children aged 6–10 years old.[22]

Body mass index measurement

BMI was calculated using the standard formula weight (kg)/height (m)2 with the height and weight measured as per the standard protocol.

Skinfold thickness

Skinfold thickness measurements at the following areas were taken:

  • Triceps: a fold along the vertical axis of the humerus on the midline of the posterior aspect of the upper arm, halfway between the acromion process of the scapula, and the olecranon process of the ulna were taken
  • Abdomen: a longitudinal fold, 2 cm to the right of the umbilicus was measured
  • Thigh: a longitudinal fold on the anterior midline of the thigh, halfway between the superior border of the patella, and the inguinal crease were measured
  • Lower-extremity muscle strength: the strength of the lower-extremity musculature (quadriceps, hamstrings, hip extensors, hip abductors, and dorsiflexors) was measured in a standard testing position, respectively, on both sides using a hand-held push-pull dynamometer.[23] The technique was demonstrated to perform the muscle action required for assessing the strength. Three practice trials were given to understand the procedure following which the final measurement was taken.


Agility (modified t-test)

The t-test includes forward and backward running and left and right side shuffling. The time taken to complete the test was noted pre- and post-training in seconds.

Procedure

The training sessions were carried out under the supervision of the investigator with necessary safety precautions during the physical education class of the children with 12 sessions conducted over a 4-week period and three sessions/week on nonconsecutive days [Table 1].
Table 1: Training protocol

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Each session lasted for 40 min with 20 min exercise and 10 min each of warm and cool down phase. The exercises under the training program included a 5 m forward run, a 5 m backward run, a 5 m shuffle to the right, and a 5 m shuffle to the left (adopted from a protocol by Yanci et al.).[24] The distance of each exercise was progressively increased up to 10 m once the program started in weekly increments. The number of repetitions also increased from 1 to 3 for each exercise.

All the outcome measures were measured at the end of the 2nd week and 4th week.

Statistical analysis

SPSS version 20.0 (SPSS 20, IBM, Armonk, NY, USA) was used for statistical analysis with the level of statistical significance taken as P < 0.05. Standard statistical measures such as the mean and standard deviation were used for the demographic profile, and Chi-square test used to assess their significance. Wilcoxon matched-pairs test was used for comparing the pre to post of all outcome variables.


  Results Top


Eleven male (55%) and nine female participants (45%) formed the sample of 20 children with a mean age of 8.70 years. Maximum number of children was in the age of 9 years [Table 2].
Table 2: Demographic profile

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Statistically significant changes from pre to post 4 weeks intervention were noted in most of the outcome measures, most notably motor proficiency (both locomotor and object control components; P = 0.0001), body weight (P = 0.0004), triceps skinfold thickness (P = 0.0033), strength of hip extensors (P = 0.0002), and agility (P = 0.0003) [Table 3], [Table 4], [Table 5], [Table 6].
Table 3: Pre-post changes in weight (kg) and triceps skinfold measurements

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Table 4: Pre-post changes in hip extensors and dorsiflexors strength (kg)

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Table 5: Pre-post changes in locomotor and object control scores (test of gross motor development-2)

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Table 6: Pre-post changes in agility scores

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  Discussion Top


The effect of agility training exercise on motor proficiency and anthropometry in obese children was studied in this pre-post experimental study. The participants trained 3 days a week for 4 weeks with each session lasting 40 min including 10 min each of warm up and cool down.

Exercise training has shown to bring about significant metabolic changes in the skeletal muscle. There is a substantial increase in both volume and density of concentration of mitochondria. There is a significant increase in myoglobin content of the muscle which causes an increase in oxygen storage capacity of individual muscle fibers. The muscle adapts to the stress imposed by exercise by increasing capillarity, and hence, blood supply to the trained muscle, greatly enhancing the oxidative capacity of the muscle. Specific training may lead to an increase in the glycogen stores in the muscle, the ability of the muscle to mobilize free fatty acids and use it as energy. Fatty acids are mobilized from fat stores due to increase in enzymes responsible for oxidation following training. Increased reliance of fat as fuel helps in conservation of muscle glycogen.

As more fat mass is used for producing energy, it causes a reduction in weight, thereby also affecting the BMI. A similar picture was noted in this study where following the 4 weeks training, the children showed a statistically significant changes in the weight as well as BMI and skinfold measurements, most notably triceps skin fold.

Development of FMS responds better to a structured physical activity than nonstructured activity.[10] The agility training in this study included specific training exercises arranged in a blocked manner. The appropriate exercise selection and proper prescription of number of sets and repetitions during the 4 weeks in a progressive manner may have contributed to the betterment of FMS in obese children.

Current evidence suggests that 30–40 min of mild-to-moderate exercises/day is required to prevent weight gain, whereas 60–90 min of moderate exercise is required for sustained the long-term weight reduction.[25] Training in this study was done for 40 min in total with the exercises being done for 20 min only. This could possibly be the reason why major clinically significant changes were not noted even though a statistical change was seen.

School-based intervention programs have shown success in lowering the BMI and also in altering anthropometric parameters of BMI and motor skills among children using different types of physical activity programs. In this study also, a school-based agility training was given to the children for 4 weeks which resulted in statistically significant reduction in weight and other parameters as well.[26] The acceptance and feasibility of school-based programs are better as the children are not overburdened with additional physical activity. The training protocol can easily be incorporated in the regular physical education programs prevalent in schools which might prove beneficial. In sprinting, muscles of the lower extremity, including those of the hip, knee, and ankle are the key components for forward propulsion of the body. As our training included sprinting in a progressive manner and over a 4 week period, the strength of the hip extensors, hamstrings, and ankle dorsiflexors showed a statistically and clinically significant change.[27] Due to the limited time allotted for the study by the school authorities during school hours, longer duration training could not be performed which could have produced better results. Co-curricular activities and dietary intake of the child could not be monitored which may influence the outcome. Uniformity in the training time during the day was not possible due to varied school protocols and time allotted by the authorities.


  Conclusion Top


School-based 4 weeks agility training program of low-to-moderate intensity (contextual interference) is effective in improving motor proficiency and also altering anthropometric parameters in obese children of 6–10 years old. Secondary changes in muscle strength of lower extremity have been noted.

In future, a structured agility training program incorporated into the regular physical education protocol in schools may prove beneficial in managing the increasing menace of overweight and obesity in children, especially in the lower age groups. Studies incorporating dietary modifications with active involvement of parents in training may add to better results and also help in improving the maintenance of weight changes and compliance to the program. An assessment of psychological factors in the context of increased weight and response to exercise may be done to enable management of the children as a whole and also to help improve the quality of life.

Acknowledgment

We are grateful to the parents of the children and school authorities for granting permission to conduct the study and most importantly grateful to all the participants for being a part of this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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