Impact and Implementation of an Early Years Fundamental Motor Skills Intervention for Children 4-5 Years.

Fundamental motor skills (FMS) are the cornerstone of a child's motor development, but concerns remain on the current level of FMS competencies, and intervention is required. This evaluation investigated if a targeted Early Years FMS intervention, delivered by a specialist physical education (PE) provider, improved the FMS of 4-5-year-old children across multiple sites. METHODS: The Early Years FMS intervention ran for 18 weeks, 1 h/week, using a standardised programme of activities to develop FMS competencies across 219 children from 15 schools in the Midlands, UK. An adapted assessment was employed as a measure of FMS, assessing locomotor, object control, and stability skills at weeks 1, 9, and 18. The FMS were each rated as green = competent, amber = working towards, or red = not meeting the standards of the skill. A description of key programme implementation characteristics was described. FINDINGS: Statistically significant increases in FMS competencies were achieved for 80% of participants at 18 weeks. Key implementation characteristics for the intervention included consistent staffing, a standardised programme, and a variety of pedagogical approaches delivered by specialist PE staff. CONCLUSION: This evaluation provided important insights into the effectiveness and implementation of the Early Years FMS intervention to improve FMS competencies in children aged 4-5 years.

The Impact of Swimming on Fundamental Movement Skill Development in Children (3-11 Years): A Systematic Literature Review.

Swimming is the only sport providing lifesaving skills, reducing the risk of death by drowning, a top cause of deaths in children aged 1-14 years. Research shows swimming amongst other sports can aid fundamental movement skill (FMS) development. Therefore, this review investigated the following: (1) how swimming impacts FMS development in children aged 3-11 years, (2) successful tools assessing swimming and FMS, and (3) recommendations appropriate to the UK curriculum based on findings of this study. A systematic literature review using Google Scholar, PubMed, and SPORTDiscuss was conducted to investigate the effects of swimming on FMS development. Methods included database searching, finalising articles appropriate to the inclusion and exclusion criteria, and identifying relevant articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The Mixed Methods Appraisal Tool assessed data quality and bias risk, whilst thematic analysis synthesised data alongside descriptive results. Ten papers were synthesised, identifying significant positive impacts of swimming on FMS, including significant pre-post testing (p < 0.01), significant improvements compared to other sports (p < 0.001), and significant improvements in specific motor skills (Balance; p = 0.0004). Future research specifically addressing swimming and FMS is essential to improving the curriculum.

Direct Parent Engagement to Improve Fundamental Movement Skills in Children: A Systematic Review.

Fundamental movement skills (FMS) are basic movements in children that represent the building blocks for more complex motor skill development and act as a prerequisite for enduring sport and physical activity (PA) engagement and positive health-related behaviours. The FMS proficiency is currently inadequate worldwide, and consequently there are alarming levels of inactivity and childhood obesity. However, parents are role models to their children and possess the power to influence their PA behaviour. This review investigated if parent-focused interventions could improve FMS in 2-7-year-old children and evaluated which setting and method of parent engagement was most impactful. Keyword searches were conducted via Scopus, Web of Science, SPORTDiscus, PubMed, Science Direct, and Google Scholar. Only nine articles met the inclusion criteria. No research originated from the United Kingdom, highlighting the urgent need for further FMS interventions involving parents. The FMS improved in all nine studies, with significant changes in seven of the articles (p < 0.05). Parent-child co-activity, the education and empowerment of parents, and the provision of clear FMS guidance, messaging, and structure can positively influence children's FMS. Recently, smartphone apps have increased the feasibility and accessibility of FMS practice at home and may be integral to future interventions. Further research with direct parental involvement is clearly warranted.

Improving Fundamental Movement Skills during Early Childhood: An Intervention Mapping Approach.

The earlier in life that a child can begin mastering fundamental movement skills (FMS), the more positive their physical activity (PA) trajectories and health outcomes are. To achieve sufficient development in FMS, children must be guided with tuition and practice opportunities. Schools and educators provide an opportunity for interventions that improve health behaviours and outcomes for children. The aim of this study was to use intervention mapping (IM) to design a programme of school-based intervention to improve FMS for children aged 4-5 years old. Following the six steps of IM, with each step comprising three to five tasks that require the input of a planning group formed by key stakeholders, a programme of intervention was planned. Prior knowledge and primary and secondary evidence was used to support the development of the programme. A logic model of the problem as well as logic models of change, programme design, production, implementation, and evaluation were proposed or completed within the study. The results can be used to begin to implement an FMS-focussed intervention within school settings within England and propose a sustainable and realistic approach for helping children to develop FMS with the support of well-informed educators who are confident to deliver better FMS practice and PA opportunities.

The Effects of Physical Activity on Academic Performance in School-Aged Children: A Systematic Review.

Schools offer a unique environment to influence children's physical activity (PA) levels positively. This study aims to systematically review the evidence surrounding how PA affects academic performance by analysing how the frequency, intensity, time, and type of PA mediate academic performance outcomes. This review was conducted using the PRISMA framework. Keyword searches were conducted in Science Direct, PubMed, and SPORTDiscus. Children that were obese, typically developing, typical weight, disabled, with a developmental disability, from a low socio-economic background, or an ethnic minority were included. A total of 19 studies were included, with a total of 6788 participants, a mean age of 9.3 years (50.2% boys, and 49.8% girls). Overall, 63.2% were nondisabled, while 36.8% were diagnosed with a disability. Two authors met, reviewed papers with regard to the inclusion criteria, and agreed on outputs to be included. Evidence suggests that associations between PA and academic performance were primarily positive or nonsignificant. PA levels of 90 min plus per week were associated with improved academic performance, as was PA performed at moderate to vigorous intensity. The optimal duration of PA was 30-60 min per session, whilst various sports induced positive academic effects. Importantly, findings support that PA does not have a deleterious effect on academic performance but can enhance it.

An Investigation into the Physical Activity Experiences of People Living with and beyond Cancer during the COVID-19 Pandemic.

This study investigated the physical activity experiences of people living with and beyond cancer (PLWBC) during the COVID-19 pandemic. Participants attended the cancer and rehabilitation exercise (CARE) programme delivered by a football community trust. Staff (n = 2) and participants (n = 9) attended semi-structured interviews investigating the PA participation and experiences of attending/delivering different modes of CARE, including exercise classes delivered outdoors and delivered online. Interviews also investigated participant aspirations for returning to CARE sessions delivered in person indoors. The findings show that the COVID-19 pandemic and government restrictions impacted on PA participation, yet exercise sessions provided via CARE offered participants an important opportunity to arrest their inactivity, keep active and maintain their fitness and functionality. Barriers to participation of CARE online included access to IT infrastructure, internet connectivity and IT skills and comfort using IT. Regarding CARE outdoors, the weather, range of equipment, variety of exercises and the lack of toilets and seats were barriers. In the different CARE modes, the skills of delivery staff who were sensitive to the needs of participants, social support, and the need for participants to maintain good mental and social health were important facilitators for engagement and are considerations for programme delivery. CARE helped PLWBC to keep physically active.

The Role of Physical Activity in Cancer Recovery: An Exercise Practitioner's Perspective.

Less than 20% of cancer patients meet the recommended physical activity (PA) guidelines, partially due to poor knowledge and enforcement/encouragement amongst health-care professionals (HCPs). The primary aim of this study was to explore the perceptions of exercise practitioners on the role of PA and the physiological and psychological benefits to recovering cancer patients; the secondary aim was to understand the barriers and facilitators of promoting PA to cancer survivors. The third aim was to, seek the perspectives on the effectiveness of referral systems between the hospitals and PA structures. A purposive sample of five exercise practitioners' (four male and one female) with experience with cancer patients participated in a semi-structured interview (45-60 min). Interviews addressed five key topics: intervention procedures, patient well-being, patient education on PA, effectiveness of referrals from hospitals, and post-intervention PA. Interviews were transcribed verbatim and analysed via thematic analysis. The participants believed that recovering cancer patients possess a knowledge of the physiological benefits of PA, yet psychological understanding remains unknown. Social environments are key to participation in PA and most HCPs lacked knowledge/awareness of the benefits of engaging in PA. There is a need to improve HCPs knowledge of the benefits of PA, whilst providing standardised training on how PA can improve cancer patients' outcomes.

Influence of the COVID-19 Lockdown on the Physical and Psychosocial Well-being and Work Productivity of Remote Workers: Cross-sectional Correlational Study.

BACKGROUND: Lockdowns imposed during the COVID-19 pandemic have impacted the living and working habits of millions of people, with potentially important implications for their physical, mental, and social well-being. OBJECTIVE: The primary objective of this study was to investigate the impact of the COVID-19 pandemic on remote workers who were not directly affected by COVID-19. METHODS: This was a correlational cross-sectional study (with an additional qualitative component) of 184 remote workers surveyed during the first COVID-19 lockdown in the United Kingdom. Standard measures of mental health (Kessler-6 Distress Scale), productivity (Brief Instrument to Assess Workers' Productivity During a Working Day), and physical activity (International Physical Activity Questionnaire) were used, and respondents were further surveyed on changes to their dietary, exercise, smoking, drinking, and socialization habits to produce a well-being change index. RESULTS: The results revealed associations between sedentary behavior and poorer mental health (τ b=0.14) and between poorer mental health and low work productivity (τ b=-0.39). However, both positive and negative lifestyle changes were reported; a self-reported increase in well-being (with respect to diet, exercise, smoking, alcohol consumption, and socialization) since the start of the pandemic was associated with both better mental health (τ b=-0.14) and better work productivity (τ b=0.14). Of note, among respondents without a mental health diagnosis (137/184, 74.4%), we observed rates of moderate (76/137, 55.5%) and severe (17/137, 12.4%) psychological distress, which were markedly higher than those reported in large prepandemic studies; moreover, 70.1% (129/184) of our respondents reported more sedentary behavior, 41% (69/168) increased their alcohol consumption, and 38.6% (71/184) increased their overall food intake. However, 46% (75/163), 44.8% (39/87) and 51.8% (57/110) of respondents reported spending more time walking and engaging in more moderate and vigorous exercise, respectively. Qualitative analysis revealed many positive adaptations to lockdowns (eg, decreased commuting expenses, flexibility) but also a number of structural obstacles to remote working (eg, lack of support and high expectations from employers, childcare duties). CONCLUSIONS: These findings may be of practical importance for policy makers and employers in a world in which work involves long-term remote or hybrid employment arrangements; strategies to promote more sustainable remote working are discussed.

The 24-h Movement Compositions in Weekday, Weekend Day or Four-Day Periods Differentially Associate with Fundamental Movement Skills.

The aim of this study was to investigate the relationship between weekday, weekend day and four-day physical activity (PA) behaviours and fundamental movement skills (FMS) in British preschool children from a low socio-economic status background using compositional data analysis (CoDA). One hundred and eighty-five preschool children aged 3-4 years provided objectively assessed PA and sedentary behaviour (SB) data (GENEActiv accelerometer) and FMS (TGMD-2). The association of 24-h movement behaviours with FMS was explored using CoDA and isotemporal substitution (R Core Team, 3.6.1). When data were considered compositionally (SB, light PA (LPA), moderate and vigorous PA (MVPA)) and adjusted for age, BMI and sex, the weekday-derived composition predicted total motor competence (r2 = 0.07), locomotor (r2 = 0.08) and object control skills (r2 = 0.09); the weekend day-derived composition predicted total motor competence (r2 = 0.03) and object control skills (r2 = 0.03), the 4-day-derived composition predicted total motor competence (r2 = 0.07), locomotor (r2 = 0.07) and object control skills (r2 = 0.06) (all p < 0.05). Reallocation of 5 min of LPA at the expense of any behaviour was associated with significant improvements in total motor competence, locomotor and object control skills; for weekend-derived behaviours, MVPA was preferential. Considering movement behaviours over different time periods is required to better understand the effect of the 24-h movement composition on FMS in preschool children.

Multi-Component Physical Activity Interventions in the UK Must Consider Determinants of Activity to Increase Effectiveness.

Interventions to increase physical activity in children have adopted broad approaches and achieved varying success. There is a need to adopt approaches underpinned with a theoretical basis. Accordingly, the aim here was to implement and evaluate a 12-week intervention designed using the concepts of the COM-B model to determine the effect this has on physical activity levels. One hundred and forty-seven school-age children (mean age 8.9 ± 1.3 years) took part in a 12-week program delivered in a school setting. Topics included physical activity, healthy eating, sleep quality and reducing screen time/sedentary activities when not in school. A sample of participants wore a wrist-worn accelerometer for seven days pre-and post-intervention (N = 11). The physical activity frequency was unchanged (2.9 ± 1.0 AU) when compared with post-intervention values (3.1 ± 0.8 AU, mean increase 6.8 ± 3.7%, p > 0.05). Changes were observed in the daily consumption of fruit and vegetables (pre-intervention 44.6% vs. post-intervention 60.2%, p < 0.05). Sedentary time, light activity, moderate activity and vigorous activity were unchanged post-intervention (p > 0.05). There is a need to adopt a broader approach that incorporates a theoretical basis and considers the complex ways by which physical activity behaviours are influenced.

Educators Perspectives on the Value of Physical Education, Physical Activity and Fundamental Movement Skills for Early Years Foundation Stage Children in England.

There is a lack of information available for physical education (PE) provision in the early years foundation stage (EYFS), prompting concern about what is currently delivered in schools and the values behind the approaches taken. Using semi-structured interviews, this study investigated educators' perspectives on the value of PE and physical activity (PA) for EYFS children across England in relation to opportunities for, barriers to, and benefits of PA and PE. This study collected important stakeholder views and can help shape the impact and implementation of fundamental movement skills (FMS) and PA interventions at the EYFS.

Fundamental Movement Skills and Accelerometer-Measured Physical Activity Levels during Early Childhood: A Systematic Review.

Early childhood is a key period for children to begin developing and practicing fundamental movement skills (FMS), while aiming to perform sufficient physical activity (PA). This study reviews the current evidence for the levels of achievement in FMS and PA measured using accelerometers among 4-5-year-old children and examines differences by gender. This review was conducted using the PRISMA framework. Keyword searches were conducted in Pubmed, Medline, Google Scholar and SPORTDiscus. Inclusion criteria included age: 4-5 years old; FMS measurement: Test of Gross Motor Development 2 and 3; PA measurement: objective methods; balance measurement: static single limb; study design: cross-sectional observational/descriptive, randomised control trials, intervention studies; language: English. Twenty-eight articles from twenty-one countries met the inclusion criteria and were split into either FMS and PA articles (n = 10) or balance articles (n = 18). Three articles showed children achieving 60 min of moderate to vigorous PA per day, two articles demonstrated significant differences between girls' and boys' performance of locomotor skills and five reported locomotor skills to be more proficient than object control skills at this age for both genders. Balance was measured in time (n = 12), points score (n = 3) or biomechanical variables (n = 3), displaying heterogeneity of not only measurement but also outcomes within these data, with static single limb balance held between 6.67 to 87.6 s within the articles. Four articles reported girls to have better balance than boys. There is little conclusive evidence of the current levels for FMS, PA and balance achievement in young children 4-5 years of age. The academic literature consistently reports low levels of FMS competence and mixed evidence for PA levels. Inconsistencies lie in balance measurement methodology, with broad-ranging outcomes of both low and high achievement at 4-5 years old. Further research is required to focus on increasing practice opportunities for children to improve their FMS, increase PA levels and establish sufficient balance ability. Consistent and comparable outcomes during early childhood through more homogenous methodologies are warranted.

Calibration and Cross-Validation of Accelerometery for Estimating Movement Skills in Children Aged 8-12 Years.

(1) Background: This study sought to calibrate triaxial accelerometery, worn on both wrists, waist and both ankles, during children's physical activity (PA), with particular attention to object control motor skills performed at a fast and slow cadence, and to cross-validate the accelerometer cut-points derived from the calibration using an independent dataset. (2) Methods: Twenty boys (10.1 ±1.5 years) undertook seven, five-minute bouts of activity lying supine, standing, running (4.5kmph-1) instep passing a football (fast and slow cadence), dribbling a football (fast and slow cadence), whilst wearing five GENEActiv accelerometers on their non-dominant and dominant wrists and ankles and waist. VO2 was assessed concurrently using indirect calorimetry. ROC curve analysis was used to generate cut-points representing sedentary, light and moderate PA. The cut-points were then cross-validated using independent data from 30 children (9.4 ± 1.4 years), who had undertaken similar activities whilst wearing accelerometers and being assessed for VO2. (3) Results: GENEActiv monitors were able to discriminate sedentary activity to an excellent level irrespective of wear location. For moderate PA, discrimination of activity was considered good for monitors placed on the dominant wrist, waist, non-dominant and dominant ankles but fair for the non-dominant wrist. Applying the cut-points to the cross-validation sample indicated that cut-points validated in the calibration were able to successfully discriminate sedentary behaviour and moderate PA to an excellent standard and light PA to a fair standard. (4) Conclusions: Cut-points derived from this calibration demonstrate an excellent ability to discriminate children's sedentary behaviour and moderate intensity PA comprising motor skill activity.

Cross-validation of Actigraph derived accelerometer cut-points for assessment of sedentary behaviour and physical activity in children aged 8-11 years.

AIM: To cross-validate previously calibrated Actigraph cut-points in children. METHODS: Twenty-eight children (50% boys) aged between 8 and 11 years of age (9.4 ± 1.4 years) performed a series of 5 minute bouts of activity reflective of different levels of PA from sedentary behaviour (SB) to moderate to vigorous physical activity (MVPA); V˙ O2 was assessed using breath-by-breath indirect calorimetry, and activity was assessed using Actigraph accelerometers worn on the hip and non-dominant wrist. The V˙ O2 values were then converted into age-specific METs (measured METs) and coded as SB, light PA and MVPA. Accelerometer data were analysed using previously calibrated cut-points at different epochs, that is 5, 15, 30 and 60 seconds. RESULTS: Receiver operating characteristic (ROC) curve analysis indicated that there was excellent discrimination of SB using the Evenson et al (15 seconds), Romanzini (15 seconds), Treuth et al (30 seconds), Freedson et al (60 seconds), Treuth et al (60 seconds) and Troiano et al (60 seconds) cut-points. ROC analysis indicated poor discrimination for LPA irrespective of the cut-points used. Good discrimination of MVPA was evident for all existing cut-points using a 60-second epoch. CONCLUSION: There is considerable variation in the performance of existing cut-points for assessment of SB, LPA and MPA in children.

Accelerometer-based physical activity levels, fundamental movement skills and weight status in British preschool children from a deprived area.

Preschool children are recommended to participate in a minimum of 180-min physical activity (PA) per day to enhance their development and overall health. Low PA and increased obesity are thought to be linked to low mastery of fundamental movement skills (FMS) in preschool children. This study sought to investigate whether FMS influences PA levels and weight status in preschool children, in an area of low socioeconomic status. Secondary aims of this study were to determine whether gender or day of the week affected the primary outcomes. One hundred eighty-five preschool children aged 3-4 years old, participated in the study. FMS proficiency was determined using the Test of Gross Motor Development-2. PA was determined using triaxial accelerometry over a 4-day period. None of the samples met the recommended 180 min of PA. There were no significant differences in PA or weight status between preschool children with high, medium or low FMS mastery (P < 0.05). There were also no significant correlations between overall FMS and moderate to vigorous PA during the week or weekend days.Conclusion: Girls scored significantly greater at the hop, leap, and skip (locomotor skills) and the boys significantly higher at the kick (object control) (P < 0.05). There were no significant differences in PA or weight status between preschool children with high, medium, or low FMS mastery, possibly because FMS mastery had not developed to a high enough level to affect PA and FMS are considered independent of physical fitness and physical features, such as weight and height. What is Known: •FMS are commonly developed in early childhood, providing the building blocks for future motor skills, good health and lifelong PA. •No study to date has measured FMS, PA levels and weight status in preschool children, to determine whether FMS competency influences PA levels and weight status in preschool children, in an area of low SES. What is New: •FMS competency did not appear to influence the level of PA or weight status in this sample of UK preschool children from a low SES area. •PA and FMS may not be fully established and consequently not strongly linked at the ages of 3-4 years, therefore, the preschool years could be influential in providing a window to maximise input of good/optimal development of motor competence before the proficiency barrier sets in and we need remedial intervention.

Estimating Physical Activity in Children Aged 8-11 Years Using Accelerometry: Contributions From Fundamental Movement Skills and Different Accelerometer Placements.

Accelerometers are widely used to assess physical activity, but it is unclear how effective accelerometers are in capturing fundamental movement skills in children. This study examined the energy expenditure during different physical activities (PA) and calibrated triaxial accelerometry, worn at the wrist, waist and ankle, during children's PA with attention to object control movement skills and cycling. Thirty children (14 girls) aged 8 to 11 years wore a GENEActiv accelerometer on their non-dominant wrist, dominant wrist, waist and ankle. Children undertook eight, 5-min bouts of activity comprising being lay supine, playing with Lego, slow walking, medium walking, medium paced running, overarm throwing and catching, instep passing a football and cycling at 35 W. VO2 was assessed concurrently using indirect calorimetry. Indirect calorimetry indicated that being lay supine and playing with Lego were classified as sedentary in nature (<1.5 METs), slow paced walking, medium placed walking and throwing and catching were classified as light (1.51-2.99 METs) and running, cycling and instep passing were classified as moderate intensity (>3 METs). ROC curve analysis indicated that discrimination of sedentary activity was excellent for all placements although the ankle performed better than other locations. This pattern was replicated for moderate physical activity (MPA) where the ankle performed better than other locations. Data were reanalyzed removing cycling from the data set. When this analysis was undertaken discrimination of sedentary activity remained excellent for all locations. For MPA discrimination of activity was considered good for waist and ankle placement and fair for placement on either wrist. The current study is the first to quantify energy expenditure in object control fundamental movement skills via indirect calorimetry in children aged 8-11 years whilst also calibrating GENEActiv accelerometers worn at four body locations. Results suggest throwing and catching is categorized as light intensity and instep kicking a football moderate intensity, resulting in energy expenditure equivalent to slow or medium paced walking or cycling and running, respectively. Ankle worn accelerometry appears to provide the most suitable wear location to quantify MPA including ambulatory activity, object control skills and cycling, in children aged 8-11 years.

Accelerometer-Based Physical Activity Levels Differ between Week and Weekend Days in British Preschool Children.

Participation in physical activity (PA) is fundamental to children's future health. Studies examining the temporal pattern of PA between weekdays and weekends in British preschool children are lacking. Therefore, the aim of this study was to compare PA levels between week and weekend days for UK preschool children, using objective measurements. One hundred and eighty-five preschool children (99 boys, 86 girls, aged 4-5 years), from central England wore a triaxial accelerometer (GENEActiv) for 4 days to determine PA. The time (min) and percentage (%) of time spent in light, moderate and vigorous PA (MVPA) was determined using specific cut-points for counts per minute related to 3-5 year olds. Of the sample, none of the children met the UK recommended 180 min or more of PA per day. A significant difference (P < 0.05) was observed between the amount of time that preschool children spent in sedentary behaviours on weekdays (91.9%) compared to weekend days (96.9%). During weekdays and weekend days, 6.3% and 2.0% of time was spent in MVPA, respectively. Therefore, a substantial proportion of British preschool children's day is spent in sedentary behaviours, with less MVPA accrued during the weekend. Regular engagement during the weekdays provides opportunities to accrue PA, which may not be present on weekend days.

Calibration of GENEActiv accelerometer wrist cut-points for the assessment of physical activity intensity of preschool aged children.

This study sought to validate cut-points for use of wrist-worn GENEActiv accelerometer data, to analyse preschool children's (4 to 5 year olds) physical activity (PA) levels via calibration with oxygen consumption values (VO2). This was a laboratory-based calibration study. Twenty-one preschool children, aged 4.7 ± 0.5 years old, completed six activities (ranging from lying supine to running) whilst wearing the GENEActiv accelerometers at two locations (left and right wrist), these being the participants' non-dominant and dominant wrist, and a Cortex face mask for gas analysis. VO2 data was used for the assessment of criterion validity. Location specific activity intensity cut-points were established via receiver operator characteristic curve (ROC) analysis. The GENEActiv accelerometers, irrespective of their location, accurately discriminated between all PA intensities (sedentary, light, and moderate and above), with the dominant wrist monitor providing a slightly more precise discrimination at light PA and the non-dominant at the sedentary behaviour and moderate and above intensity levels (area under the curve (AUC) for non-dominant = 0.749-0.993, compared to AUC dominant = 0.760-0.988). CONCLUSION: This study establishes wrist-worn physical activity cut-points for the GENEActiv accelerometer in preschoolers. What is Known: • GENEActiv accelerometers have been validated as a PA measurement tool in adolescents and adults. • No study to date has validated the GENEActiv accelerometers in preschoolers. What is New: • Cut-points were determined for the wrist-worn GENEActiv accelerometer in preschoolers. • These cut-points can be used in future research to help classify and increase preschoolers' compliance rates with PA.

[Calcaneus fractures]. / Kalkaneusfrakturen.

Fractures of the calcaneus generally occur in the setting of high-energy trauma, resulting in complex, three-dimensionally oriented fracture patterns. Surgical treatment is typically indicated for displaced intra-articular fractures, permitting restoration of calcaneal height, width and overall morphology, in addition to the posterior facet articular surface where possible, and enabling late in situ arthrodesis as a means of salvage in the event of post-traumatic arthritis. The present article briefly discusses our preferred methods for the management of calcaneal fractures. An English full text version of this article is available at SpringerLink as supplemental.

An update on the management of high-energy pilon fractures.

High energy pilon fractures present a unique challenge to the patient and orthopaedic surgeon. Care for the soft tissue envelope is as important as management of this articular fracture. This article reviews the fundamental principles for treatment of the patient with severe pilon fracture. Staged operative care is emphasised to prevent wound and infectious complications which have historically plagued pilon fracture surgery. New innovations directed at improving results are discussed including biological planting and wound care using the vacuum assisted closure device. Lastly, validated outcomes are presented which highlight the severity of these injuries despite optimal care.