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\begin{document}


\def\RunningAuthor{Monisha R and Ganapathy Sankar U}
\firstPage{6553}
\articleType{Original Article}
\receivedDate{02 Feb 2020}
\acceptedDate{04 Mar 2020}
\revisedDate{03 Mar 2020}
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\title{\textbf{Evaluation of Aerobic Fitness among Children with Developmental Coordination Disorder}}
\author{Ganapathy~Sankar~U, 
            Monisha~R\textsuperscript{*}~\\[5pt]{SRM College of Occupational Therapy, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur, Kanchipuram, Chennai-603 203, Tamil Nadu, India}}

\begin{abstract}
A characteristic hallmark motor in proficiency marks developmental coordination disorder (DCD). Children with DCD have low confidence in their physical abilities and lower perceived self-efficacy toward physical activities than their age-matched peer-group children without DCD. The study aims to evaluate aerobic fitness among children diagnosed with Developmental Coordination Disorder and to examine whether their lies any individual differences among children, who were suspects of DCD. Twenty children were enrolled in after baseline examination as DCD using DCDQ. Each child completed 6 Minute Walk test and Children's Self-perception of Adequacy in and the predilection for Physical Activity (CSAPPA). When considering the individual differences among children with DCD, there occurs a different result and cardiovascular fitness trend in children with DCD. Fitness is related to the self-perception of ability among children. This study provides evidence that self-perception ability among children is an essential component that needs to be considered when planning therapeutic intervention to enhance cardiovascular fitness in children with DCD. 
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Aerobic fitness,\newline Primary school children,\newline DCD,\newline 6MWT,\newline CSAPPA
\end{keywords}
\twocolumn[ \maketitle {\printKwdAbsBox}]
\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ Monisha~R~\\ Phone:\ 9940228679~\\  Email:\ monisha\_ravikumar@srmuniv.ac.in
        \par}\vspace*{-11pt}\hrulefill\par{\fontsize{12}{14}\selectfont ISSN: 0975-7538}\par% 
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\section{Introduction }
A characteristic hallmark motor in proficiency marks developmental coordination disorder (DCD). Due to motor coordination defect, there exist significant impairments in performing the daily routine and in academic functioning. Prevalence estimates identified 5\% to 9\% of children with DCD in primary schools, confined that DCD {\textendash} the most common childhood disorders \unskip~\citep{899337:20464176,899337:20464174}. However, DCD often left without diagnosed, and children were misdiagnosed and termed as clumsy, awkward and lazy. However, it has been demonstrated that because of various factors, children with DCD have low levels of aerobic fitness. But the reason behind the low level of cardiovascular fitness is left without much attention by the researchers \unskip~\citep{899337:20464181}. 

A potential factor which facilitates and hinders the performance of a child with DCD in physical activity sessions is his/her level of perceived adequacy regarding the engagement in aerobics. Perceived adequacy is elaborated as one's capacity and willingness to acquire the highest or acceptable standards of physical activity successfully, and the highest standard/ highest level should be set by the children, parents or peer group. Physical competency is necessary for performing physical activity, but insufficient prerequisite for adequacy can hinder the performance \unskip~\citep{899337:20464182,899337:20464179}.

Children with DCD have low confidence in their physical abilities and lower perceived self-efficacy toward physical activities than their age-matched peer-group children without DCD.

Perceived adequacy plays an important role in enhancing physical activity and performance in aerobic testing, and mainly the enhanced participation is seen and documented in children during the field tests, where children participated in competitive physical activity in groups (e.g., shuttle run) \unskip~\citep{899337:20464175}. 

However, negative perceptions of adequacy in children with DCD reported having failure and low aerobic fitness, and they perceive themselves less fit, and task completion is difficult for them. Negative perception will have an impact on physical abilities negatively. When a child is marked to have a negative perception, the task which requires minimum coordination skill itself is considered as difficult, and he/she consider themselves as less adequate to perform physical activity. He/she may give up participating in physical activities \unskip~\citep{899337:20464177}.
    
\section{Methods}
\textbf{Sample}

The study was a cross-sectional investigation of all students in grades 4 through 8 from five elementary schools. Children with learning disorders and other physical limitations were excluded. From a pool of 200, 50 children (22 males, 28 females) were participated in the current study after signing written informed consent. The Research Boards of SRM College of Occupational Therapy, SRM Institute of Science and Technology approved the research protocol. Baseline testing and follow-up took place in Primary schools. The management provided a school physical education practice room for conducting the research study. Children were assessed by the primary researcher in the classroom and then conducted the fitness testing, motor proficiency battery, and anthropometric testing. One day all the assessments were completed by the researcher. A 20-m Shuttle Run test was used to analyze aerobic capacity. This test has been used to document maximal oxygen uptake in children. During the test, the child is instructed to run back and forth in-between two lines which are separated at a distance of 20 m apart, in synchrony with a sound signal with diminishing intervals. Children were allowed to discontinue and stop running when they experience any breathing difficulty and giddiness. The test is terminated when a child is experiencing difficulty to maintain the pace for two consecutive sound signals. Several laps completed by each child is documented.

The Developmental Coordination Disorder Questionnaire (DCDQ) is used to screen children, and it is used for early identification of Developmental Coordination Disorder (DCD) in children. Perceived adequacy of physical activity was analyzed using a 7-item factor from the Children's Self-perception of Adequacy in and A predilection for Physical Activity (CSAPPA). This scale contains 20-item the measure used to assess children's self-perceptions of their adequacy in performing, and their need to participate in, physical activities \unskip~\citep{899337:20464156}. 
    
\section{Results}
Demographic data are presented in Table~\ref{tw-49c0c4611aaa}, and Table~\ref{tw-8046b86b0b93} documented mean differences between children with and without DCD in Aerobic fitness and perceived adequacy toward physical activity (see Table~\ref{tw-8046b86b0b93}). Children with DCD reported having lower VO2 \&P \textless\ 0.001) and lower perceived adequacy (P \textless\ 0.001). When three-way interaction between gender, DCD and perceived adequacy was tested, results indicate no significant difference by sex.


\begin{table*}[!htbp]
\caption{\boldmath {Demographic details - Mean differences between Children with and without DCD } }
\label{tw-49c0c4611aaa}
\def\arraystretch{1.1}
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\begin{tabulary}{\linewidth}{p{\dimexpr.2521\linewidth-2\tabcolsep}p{\dimexpr.2479\linewidth-2\tabcolsep}p{\dimexpr.2604\linewidth-2\tabcolsep}p{\dimexpr.2396\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Variables & \cAlignHack Total Sample Mean & \cAlignHack Children with DCD & \cAlignHack Non-DCD\\
\tblmidrule 
VO2 Maximum &
  \cAlignHack 25.66 &
  \cAlignHack 20.01 &
  \cAlignHack 26.00\\
Perceived Adequacy &
  \cAlignHack 22.87 &
  \cAlignHack 15.00 &
  \cAlignHack 22.89\\
Age &
  \cAlignHack 10.43 &
  \cAlignHack 10.44 &
  \cAlignHack 10.54\\
\multicolumn{4}{p{\dimexpr(1\linewidth-2\tabcolsep)}}{\textbf{Gender}}\\
Male (N) &
  \cAlignHack 22 &
  \cAlignHack 15 &
  \cAlignHack 7\\
Female &
  \cAlignHack 28 &
  \cAlignHack 20 &
  \cAlignHack 8\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Regression Amalysis} }
\label{tw-8046b86b0b93}
\def\arraystretch{1.1}
\ignorespaces 
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\begin{tabulary}{\linewidth}{p{\dimexpr.46989999999999995\linewidth-2\tabcolsep}p{\dimexpr.17539999999999996\linewidth-2\tabcolsep}p{\dimexpr.16480000000000008\linewidth-2\tabcolsep}p{\dimexpr.1899\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Variables & \cAlignHack Model 1 & \cAlignHack Model 2 & \cAlignHack Model 3\\
\tblmidrule 
Age &
  \cAlignHack -0.562 &
  \cAlignHack -0.523 &
  \cAlignHack -0.573\\
Gender &
  \cAlignHack 3.24 &
  \cAlignHack 2.87 &
  \cAlignHack 3.22\\
Perceived Adequacy &
  \cAlignHack  &
  \cAlignHack 0.322 &
  \cAlignHack 0.312\\
DCD X Gender &
  \cAlignHack  &
  \cAlignHack -1.23 &
  \cAlignHack -1.11\\
DCD X Perceived Adequacy &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack 0.0025\\
DCD X Gender X Perceived Adequacy &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack -0.054\\
r- squared &
  \cAlignHack 0.121 &
  \cAlignHack 0.215 &
  \cAlignHack 0.223\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

    
\section{DISCUSSION}
Children with DCD face challenges in performing everyday tasks. Because of their frequent failure in all the simple academic and personal activities makes them isolated in school as well as in-home. They perceive themselves as low, and their assessment of limitations in performing all the activities of daily living skills is directly related to physical factors.

When a child with DCD is assigned a physical task which is less capable for the child, his/her perception and motivation in performing as well as participating in the task will make it easier for the child. This is documented in previous researches that in few field-based aerobic tests, the nature of the child either the competitive nature or social nature of the task combined with the negative perception of the more manageable task will affect the performance.

Low aerobic fitness can be related to the child's self-perception of their fitness level, and they consider themselves a failure. So children with DCD believe themselves as less adequate to perform and complete the task, and therefore they don't initiate a try to participate in the task and also do not try as hard as other children without DCD \unskip~\citep{899337:20464180}. 

Children DCD was referred to commonly as lazy and clumsy by their teacher and parents; this makes the child a poor academic performer. Many children with DCD avoid playing with peer groups and avoids participation in physical activities. They want to avoid failure in completing a particular task. They tend to give up sooner because they believe they are incapable. 

Motor coordination difficulties experienced by children with DCD are varied. Each child is unique in their abilities; however, with the motor coordination difficulties, each child tries to excel with that difficulty. Visser et al. reported that fair motor difficulty is the most common impairment found in all the children with DCD, and it will not influence the running and walking ability of the child. The current research used a shuttle run test, which is simple and easy to perform for the majority of children with DCD. The significant advantage of using a shuttle run test is the pacing of lap \unskip~\citep{899337:20464178}. 

Few children, even if reported to have trouble with sequenced movements, will consider shuttle run test easier. No child is left out without performing the shuttle run test, at least they tend to complete one lap. The current research adds to evidence that the performance of the child in aerobic fitness test is related to the perception of the task. 

Children with DCD were instructed to complete the questionnaire before the shuttle run test; their perception towards the task is calculated before the performance and participation in the task. This can't not be related to poor performance. Thus, the child's poor performance in the field test can't be solely related to perceived adequacy\unskip~\citep{899337:20464156}. Physical consequences associated with the DCD plays another important role in hindering performance; the current study does not address the issues. 
    
\section{Conclusion }
The results conclude that aerobic fitness can be modulated with perceived adequacy and their exist individual differences among children with DCD. There is a need for awareness programme and motivation classes to enhance the participation in physical activity sessions.   
\section*{Acknowledgement }Authors thank all the participants for their willingness to participate in the study.

\textbf{Conflict of Interest}

The authors declare that they have no conflict of interest for this study.

\textbf{Funding Support}

The authors declare that they have no funding support for this study.
    

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