| Summary: | Background: Developmental Coordination Disorder (DCD) describes children with a difficulty to acquire age-specific motor skills. Although there is a significant body of literature addressing developmental and cognitive issues in children with DCD, few studies have actually examined the associations between DCD, physical activity and physical fitness. Therefore, the aim of the present research work was to assess these associations in a series of four successive studies which were set: a) (study 1) to estimate DCD prevalence rates in Greek children and investigate whether these children exhibit different obesity and cardiorespiratory fitness levels than an overseas sample, b) (study 2) to provide evidence on the association between DCD and physical fitness levels, c) (study 3) examine whether a motor skills and exercise training intervention programme affects motor proficiency in a cohort of elementary school children with and without DCD, and d) (study 4) to test the hypothesis that DCD is associated with CVD risk, identify modes of physical activity that mediate such an association and to evaluate the CSAPPA scale as a potential tool for identifying Greek children for DCD. Methods: The total of 574 Greek (Age: 11.46 ± 1.54 years; BMI: 19.96 ± 3.53) children were assessed for anthropometry, physical fitness (flexibility, hand strength, leg explosive power, speed and cardiorespiratory fitness), motor competence (i.e., short form of the Bruininks-Oseretsky Test of Motor Profiency- BOTMP-sf) and subjected to two self assessments for: i) perception of adequacy for physical activity (CSAPPA scale), and ii) children’s participation in physical activity (Participation Questionnaire - PQ). Results: Study 1: Greek children demonstrated significantly higher DCD prevalence rates (p<0.05), higher body fat (p<0.05) and were inferior in both cardiorespiratory fitness (p<0.05) and motor competence (p<0.05) compared to an overseas sample. Study 2: Greek children with DCD demonstrated significantly higher BMI values (p<0.01) and lower leg explosive power (p<0.01), speed (p<0.01) and hand strength (p<0.01) than those without DCD. Study 3: Results showed a significant main effect of time [F(14, 115) = 3.79, p< 0.001; η2 = 0.32] for motor competence (p<0.001) between children with and without DCD. Significant main effects of group (i.e intervention and control groups) [F(42, 351) = 4.01, p< 0.001; η2 = 0.33] were observed for BMI (p<0.01), motor competence (p<0.01), cardiorespiratory fitness (p<0.01), hand strength (p<0.05), leg explosive power (p<0.05), speed (p<0.01), and free time play activities (p<0.05). Study 4: Chi-square comparisons and ANOVA, revealed significantly increased body mass (p<0.05), BMI (p<0.05) and inactivity (p<0.05), as well as significantly decreased cardiorespiratory fitness (p<0.05), motor competence (p<0.05), CSAPPA indices, and participation in free play (p<0.05) in children with DCD. Furthermore, BMI and cardiorespiratory fitness were significantly associated with motor competence (p<0.05) with inactivity as the mediating factor (p<0.05). ROC curve analyses for CSAPPA indicated an optimal cut-off at 62 points. Conclusions: 1) the relatively high DCD and obesity prevalence rates together with the low cardiorespiratory fitness suggest greater health risk for Greek children with the studied condition, 2) children with DCD tend to perform worse in selected physical fitness parameters compared to their normal peers, 3) motor skills and exercise training interventions for children with DCD may improve health and skills related fitness, and 4) inactivity mediates the relationship between DCD and CVD risk in children with DCD. Finally, the CSAPPA scale may serve as a practical and a cost-effective proxy assessment for identifying Greek children with DCD, however as this is not a standardised test for use with children, its use should be treated with caution until further validation work.
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