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Project Details
Funding Scheme : General Research Fund
Project Number : 14622018
Project Title(English) : A Cluster Randomized Controlled Trial of Physical Activity Intervention on Motor and Cognitive Functions and Psychosocial Outcomes of Children with Developmental Coordination Disorder  
Project Title(Chinese) : 體力活動干預對動作協調障礙兒童動作技能、認知功能及社會心理健康影響的集群隨機對照研究 
Principal Investigator(English) : Prof Sit, Cindy Hui-ping 
Principal Investigator(Chinese) :  
Department : Dept of Sports Science & Physical Education
Institution : The Chinese University of Hong Kong
E-mail Address : sithp@cuhk.edu.hk 
Tel : 39434126 
Co - Investigator(s) :
Prof Ho, Tin Hung, Rainbow
Prof Tsai, Chia Liang
Prof Wong, Stephen Heung-sang
Dr YU, Jane Jie
Panel : Humanities, Social Sciences
Subject Area : Education
Exercise Year : 2018 / 19
Fund Approved : 727,398
Project Status : Completed
Completion Date : 31-12-2022
Project Objectives :
Examine the immediate, short- and longer-term effects of a school-based physical activity intervention on motor and cognitive functions (inhibitory control), and psychosocial outcomes (anxiety and depression, social support, self-concept) of children with DCD.
Assess the potential influence of moderating variables (gender, DCD status) on the intervention effects.
Abstract as per original application
(English/Chinese):
Development coordination disorder (DCD) is rarely recognized by educators and healthcare professionals until children begin to struggle at school. Children with DCD have deficits in motor and cognitive functions, which result in restricted participation in daily activities, poor academic performance and psychosocial outcomes such as anxiety and depression, limited social support and low self-concept. Early intervention is important because problems associated with DCD will carry over into adulthood. Conventional or therapeutic approaches to motor intervention on DCD are less promising, mainly because traditional rehabilitation practices impose economic and psychological burdens on both children with DCD and their families. In view of the positive associations of physical activity (PA) with improved cognitive function and psychosocial health in children, ecological PA intervention in the school setting has gained much attention. Our research team has conducted school-based PA interventions in children with DCD, and found significant positive effects on (1) motor performance, self-perceived competence and enjoyment; and (2) inhibitory control, a critical cognitive function that involves an ability to react and adapt to environmental changes in different contexts such as learning and social interaction. Further research is still needed to determine the sustainability of the intervention effects and determine whether improved motor and cognitive functions can translate into increases in psychosocial health as secondary outcomes in the longer term. Grounded in the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) framework, this study is the first cluster randomized controlled trial (RCT) to examine the effects of a school-based PA intervention on motor and cognitive functions (inhibitory control) and psychosocial outcomes (anxiety and depression, social support, self-concept) of children with DCD. It is also the first study to use salivary cortisol as biomarker of stress in Hong Kong children with DCD. Based on power calculation, 240 children with DCD in twelve Hong Kong primary schools will be cluster randomized allocated into either a 12-week PA intervention or a control condition. Measurements of motor performance, inhibitory control, and psychosocial outcomes (self-report, proxy-report, biomarker) will be conducted at (i) baseline, (ii) post-intervention (immediately after 12-week intervention), (iii) 3-month after post-intervention, and (iv) 12-month after post-intervention. This cluster RCT brings experts in PA interventions together, and its findings will assist educators and healthcare policy makers to develop early treatment strategies for DCD and to introduce school-based health promotion practices for children with DCD.
Realisation of objectives: Grounded in the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) framework, the purpose of this project was to examine the effects of a school-based PA intervention on motor and cognitive functions (inhibitory control), and psychosocial outcomes (depression, anxiety, stress, perceived social support, self-concept) of children with DCD using a cluster randomized controlled trial (RCT). As proposed in the protocol, a total of 240 participants from 12 schools would be included with the consideration of potential attrition. Because of the influence of the COVID-19 pandemic, the research team had faced unpredictable and great challenges. Eventually, a total of 241 children aged 6-10 years were successfully recruited from 11 local primary schools. Among 241 children, 126 of them were diagnosed as having DCD or at risk. Among the 11 participating schools, 6 schools were allocated to the intervention condition, and the other 5 schools were allocated to the control condition. A 12-week PA intervention was delivered in the intervention schools during school time, and children were required to perform activities at a moderate intensity level (50-60% of the maximum heart rate), which was objectively measured with a Polar heart rate monitor. To achieve Objective 1, a series of assessments at baseline (prior to intervention), immediately after intervention (immediate effect), 3-month post-intervention (short-term effect), and 12-month post-intervention (longer-term effect) were performed. Motor performance was assessed using the Movement Assessment Battery for Children-2nd edition (MABC-2) and relevant checklists. Cognitive function of children was assessed by the endogenous model of the Posner paradigm to determine the children’s inhibitory control ability. The psychosocial outcomes (anxiety, depression, social support, self-concept) of the children were assessed by self-reported questionnaires. In addition to self-reported measures, salivary cortisol was collected as an objective biomarker to assess stress level of children. Additionally, cardiorespiratory fitness was measured with the Pacer test, a multistage progressive 20m shuttle run test in the Brockport Physical Fitness Test Kit. Sedentary behavior and PA at different levels (i.e., light PA, moderate-to-vigorous PA [MVPA]) were objectively assessed for consecutive seven days using Actigraph accelerometers. To achieve Objective 2, information on gender and DCD status of children was either collected or determined. DCD status was assessed by the MABC-2 test and relevant checklists (e.g., Developmental Coordination Disorder Questionnaire-Chinese version completed by parents). Children with a MABC-2 total score in the 5th percentile or below were identified as DCD, and those within the 6th-15th percentile were identified as DCD. The impacts of gender and DCD status on children’s health outcomes and intervention effects were further explored. Therefore, the two objectives have been achieved.
Summary of objectives addressed:
Objectives Addressed Percentage achieved
1.Examine the immediate, short- and longer-term effects of a school-based physical activity intervention on motor and cognitive functions (inhibitory control), and psychosocial outcomes (anxiety and depression, social support, self-concept) of children with DCD.Yes100%
2.Assess the potential influence of moderating variables (gender, DCD status) on the intervention effects.Yes100%
Research Outcome
Major findings and research outcome: This project was the first attempt to determine the effects of a school-based physical activity (PA) intervention on motor performance, cognitive function, and psychosocial outcomes in school-aged children with DCD using an RCT design. The findings of this project advanced our understanding of the effectiveness of early PA intervention on the improvement of physical and mental health in children with DCD. Importantly, it helped aid the development of early treatment strategies for DCD and inclusive health promotion practices in a school setting for children with DCD in Hong Kong. Key findings of this project are presented as follows. As predicted, gender and DCD status were significant factors that influenced the expected outcomes. Compared to children with typical development (TD), children with DCD showed significant poorer motor performance, inhibitory control ability, self-concept (particularly in physical coordination and body fat), and had a higher level of anxiety. Children with DCD were also found to spend more time being sedentary in day time and had poorer cardiorespiratory fitness than their TD peers. Additionally, boys with DCD were more likely to have poorer self-concept on physical coordination and tended to experience a higher level of stress than girls with DCD, even though boys with DCD were more physically active than girls with DCD (i.e., spent shorter time being sedentary and more time in MVPA per day). However, such gender disparity was not evident in children with TD. After receiving a 12-week PA intervention during school time, children with DCD significantly reduced their stress level (based on the biomarker of salivary cortisol) and improved cardiorespiratory fitness immediate and 12-month after the intervention. The findings indicate that a school-based intervention appears to be a promising way to improve physical fitness and mental health of children with DCD and its effectiveness can be even sustained for one year. Besides, children with DCD who received the intervention also significantly increased their time spent in MVPA immediate after the intervention. However, no significant improvements were observed in other outcomes (i.e., motor performance, inhibitory control, self-concept, and social support) for children with DCD in the intervention group when compared to children with DCD in the control group. Interestingly, children with TD who received the intervention showed significant improvements in cardiorespiratory fitness (immediate, 3-month, and 12-month after the intervention), PA participation (i.e., spent shorter time being sedentary and more time in MVPA per day at 3-month after the intervention when compared to the baseline level), and mental health (i.e., reported lower levels of both depression and anxiety level immediate and 3-month after the intervention than baseline). Taken together, PA intervention developed in this project is beneficial for both children with and without DCD in terms of improving physical and psychological health.
Potential for further development of the research
and the proposed course of action:
DCD is a common neurodevelopmental disorder among school-aged children worldwide including in Hong Kong, which is rarely recognized in its early stage. Development of ecological and cost-effective intervention strategies to alleviate primary deficits of DCD and its related secondary health consequences is very important. Based on the key findings of this project, it is worth considering some gaps and directions for future development of the research in the field. First, children with DCD demonstrated significant deficits in various physical and psychosocial health outcomes as well as cognitive functions, which were moderated by gender. With the consideration of such complex situation in this group of children and limited empirical evidence up to now, more future research from a multi-disciplinary perspective is needed for a better understanding on the association of DCD deficits with healthy development in children. Second, school-based PA intervention appears to be a feasible and effective way to improve overall physical and psychological health of children with DCD. However, more future research is warranted to optimize the design of PA intervention programs tailored for children with DCD for the sake of further improvements in their psychosocial health (e.g., cognitive function, self-concept, and social support).
Layman's Summary of
Completion Report:
Children with Developmental Coordination Disorder (DCD) is a group of children who have impairments in learning and executing motor skills that significantly impact their daily activities and result in poor physical and psychosocial health consequences. Early intervention is important because problems associated with DCD will carry over into adulthood. Grounded in the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) framework, this project was the first to examine whether a 12-week physical activity intervention at school is effective (both short- and long- term) in improving physical and psychosocial health for children with DCD using a cluster randomized controlled trial. The effectiveness of intervention was determined using multi-dimensional outcomes including motor performance, cognitive (inhibitory control) and psychosocial (depression, anxiety, stress, perceived social support, self-concept) functions, physical activity (sedentary time, moderate-to-vigorous physical activity), and fitness (cardiorespiratory fitness). Our findings showed that a 12-week school-based physical activity intervention appears to be effective in improving overall physical and psychological health in children with DCD. We believe the findings gained are of significance to assist educators and healthcare policy makers in developing early treatment strategies for DCD and to introduce school-based health promotion practices for children with DCD in Hong Kong.
Research Output
Peer-reviewed journal publication(s)
arising directly from this research project :
(* denotes the corresponding author)
Recognized international conference(s)
in which paper(s) related to this research
project was/were delivered :
Month/Year/City Title Conference Name
Bangkok Relationship Between Motor Coordination and Mental Health in School-Aged Children  2023 IOHSK International Conference 
Bangkok Effects of School-based Physical Activity Intervention on Mental Health in Children with and without Developmental Coordination Disorder  2023 IOHSK International Conference 
Other impact
(e.g. award of patents or prizes,
collaboration with other research institutions,
technology transfer, etc.):

  SCREEN ID: SCRRM00542