Motor skills and fitness in African children: the PERF-FIT study

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Children with developmental delays in motor coordination are particularly less inclined to engage in physical play and sports, putting them at risk of reduced fitness, overweight, and eventually NCDs. While several motor performance tests exist, they were not designed for African children and lack valid norms. As the results of an African-led initiative, a contextually relevant motor performance test was developed, the PERFormance and FITness test battery (PERF-FIT), that is open-source and specifically tailored for low-resource African settings. This study provides the first age- and sex-specific motor skill norms for African children aged 6–12. By generating normative data alongside its previously established robust psychometric properties, the PERF-FIT is positioned as a critical resource for clinicians, educators, and policymakers working to monitor and enhance motor performance and physical fitness among African children. Health sciences/Health care/Paediatrics/Paediatric research Health sciences/Health occupations Figures Figure 1 Figure 2 Introduction Africa is home to the world’s largest child population, yet it bears a disproportionate burden of health challenges [ 1 ]. According to the World Health Organization (WHO), the continent accounts for 25% of the global disease burden but receives less than 1% of worldwide health expenditures [ 2 ]. One of the growing concerns in Africa is the increasing prevalence of non-communicable diseases (NCDs), due to shifts in lifestyle and dietary habits [ 3 , 4 ]. Early intervention, particularly through promoting physical activity and active lifestyles among children, has emerged as a key strategy in preventing NCDs and fostering long-term health [ 5 ]. A critical yet often overlooked factor in engaging children in physical activity is their motor skill proficiency [ 6 , 7 ]. Children with well-developed motor skills are more likely to participate in physical activities, while those who face developmental delays in motor coordination are less inclined to engage in physical play and sports [ 8 , 9 ]. This lack of activity can ultimately lead to lower fitness levels, which is a primary risk factor for NCDs [ 7 , 10 ]. While much of the focus on physical activity has centered on promoting exercise in adult populations, less attention has been given to the critical role motor skill development plays in shaping children’s long-term engagement with physical activity, particularly in Africa [ 7 , 11 ]. Early development of motor skills not only enhances children's ability to engage in physical activity but also plays a fundamental role in their overall health, cognitive development, and social integration [ 12 ]. Unfortunately, children in many African countries face significant barriers to developing these essential motor skills [ 13 ]. Not all children develop motor skills at the same rate, and various factors such as developmental disorders, HIV, sickle cell disease, and environmental constraints can further hinder motor development in many African children [ 14 ]. Unfortunately, the lack of standardized, contextually relevant assessments makes it difficult to identify motor delays early. While several motor performance tests exist, most are not designed for African children and lack valid norms for those aged 6–12 [ 15 ]. To address this gap, we have developed the PERFormance and FITness test battery (PERF-FIT)—a motor performance tool specifically designed for low-resource African settings. The PERF-FIT provides a set of reliable [ 16 ], feasible [ 17 ], and culturally relevant items [ 17 , 18 ] that healthcare professionals and educators can use to evaluate motor skill development and fitness in children aged 6–12. Developed with input from experts in child development and human movement science [ 17 ], it assesses key motor aspects such as agility, balance, coordination, power, and speed—all essential for fostering physical activity. Enabled by a large team of volunteers and developed in collaboration with experts from local African universities, this test provides an accessible, free tool for assessing motor skills and guiding interventions. This initiative filled the gap, offering a crucial resource for health professionals, educators, and policymakers. Our hope is that this tool will empower communities across Africa to take proactive steps towards improving children’s physical health, and by extension, their future well-being. By providing a contextually relevant tool that is both free and open-source, we aim to contribute to the United Nations’ Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being) and SDG 4 (Quality Education), while promoting a more equitable approach to addressing health disparities among African children [ 19 ]. This paper aims to establish normative data for the PERF-FIT test battery that are both age- and sex-appropriate for African children. By providing these norms, we aim to give clinicians and educators a powerful tool to identify children at risk for motor delays and low fitness, enabling early intervention that can help improve physical health outcomes and support the adoption of active lifestyles. Methods Selection of Participants Data were collected across diverse regions of Africa with large and growing populations (Table 1 ). Specifically, data were sampled from Nigeria and Ghana in West Africa, Ethiopia in East Africa, Tunisia in North Africa (replacing Sudan due to the conflict), and South Africa in Southern Africa. Efforts were made to include participants from both rural and urban areas. Ethical approval and informed consent were obtained before testing, resulting in a final sample of 2,884 African children. Table 1 Overview of African Regions with Large Growing Populations [ 20 ] Region Country Percentage of Africa Total Population Percentage Growth North Sudan 3.4% 50,042,791 1.34% Tunisia 0.9% 12,200,431 0.67% East Ethiopia 8.7% 128,691,692 2.64% West Nigeria 15.4% 227,882,945 2.12% Ghana 2.3% 33,787,914 1.93% South South Africa 4.3% 63,212,384 1.34% Study Procedure This cross-sectional study was conducted between 2019 and September 2024. All data were anonymized and analyzed using unique ID numbers. Ethical approvals were granted by the respective Human Research Ethics Committees (South Africa: HREC REF: 139/2019, HREC REF: 112/2020, NWU 00491-19-A1; Tunisia: CPP SUD N° 0301/2021; Ghana: GHS-ERC 052/05/19; Nigeria: UUTH/AD/S/96/VOL/XXI/524; Ethiopia: JUIH/IRB/691/23). Permission was also obtained from local education authorities and school administrations. Written informed consent was secured from parents, while children provided assent. All procedures adhered to the World Medical Association Declaration of Helsinki [ 21 ]. The PERF-FIT test battery was administered by trained investigators who followed standardized protocols. Training included reading the manual, practicing with both typically developing children and those with neurodevelopmental disorders, and receiving feedback on recorded or live demonstrations. Only after successful evaluations were investigators cleared to conduct testing. All testing occurred in small groups at schools, with children generally wearing school uniforms and performing barefoot due to the lack of appropriate footwear. Materials Demographic and Anthropometric Data Demographic data included age, sex, country, and location (urban/rural). Height was measured using a steel tape measure mounted on a wall, and weight was recorded using an electronic scale, both without shoes and in light clothing. Body mass index (BMI) was calculated as weight (kg) divided by height squared (m²). Children were classified into BMI categories based on International Obesity Task Force (IOTF) criteria [ 22 ]: thinness grades 1–3, normal weight, overweight, and obese. PERF-FIT Test Battery The PERF-FIT test battery targets children aged 5–12 years, including those suspected of low motor skills or fitness. It was designed to: Be culturally feasible for children aged 5–12 years. Cover all aspects of motor skill-related fitness. Require no expensive materials or specific space. The test comprises 10 items divided into two subscales: the Power and Agility Subscale (running, stepping, side jump, long jump, and overhead throw) and the Motor Skill Performance Subscale (bouncing and catching, throwing and catching, jumping and hopping, static balance, and dynamic balance tasks). Each item is described in detail in the manual ( Appendix 1 ). The test has a maximum administration time of 40 minutes. Scoring can be done using applications ( Appendix 2–4 ). The test has been validated for excellent content validity, good structural validity, high inter-rater reliability (ICC = 0.99), and good test-retest reliability (ICC = 0.80) [ 16 – 18 ]. Table 2 summarizes the psychometric characteristics. Table 2 Summary of the psychometric properties of the PERF-FIT. RELIABILITY RESPONSIVENESS Internal consistency Interrater reliability Test-retest reliability Cronbach’s Alpha 0.74* ICC = 0.99 [ 16 ] ICC > 0.80 CoV: 0–20% (excellent to good precision) [ 16 ] Children with DCD: Medium-to-large effect sizes for all PERF-FIT items, except throw & catch, after a Wii-fit intervention (12 weeks, 3x/week) [ 23 ]. Medium effect sizes for the PERF-FIT stepping and side jump items after Wii-fit/Kinect training (5 weeks, 1-2x/week) [ 24 ]. Large effects sizes on all PERF-FIT items after a task-oriented basketball-related training intervention [ 25 ]. Children with moderate thinness: Large improvements after active play intervention (12 weeks, 5x/week) on the stepping, side jump, long jump, bounce & catch, throw & catch and jumping & hopping [ 26 ]. VALIDITY Content Construct validity Criterion/ concurrent Structural Hypothesis testing Cross-cultural CVI score of 0.99 [ 17 ] Moderate correlations among balance PERF-FIT balance items [ 27 ]. Balance items load on one component indicating the same construct [ 27 ]. PERF-FIT ball skill items correlate strongly with each other and moderately with the overhead throw [ 28 ]. The PERF-FIT ball skill items load on another component than the Overhead throw, supporting the distinct construct they cover [ 28 ]. Children with DCD: severe DCD significantly poorer on the PERF-FIT bounce & catch, throw & catch and overhead throw items than moderate DCD, who perform significantly poorer than TD peers [ 29 , 30 ]. The PERF-FIT is moderately associated with the DCDDaily questionnaire total score and daily participation subscore [ 30 ]. Malnourished children: overweight children significantly poorer on static and dynamic balance tasks than normal weight peers [ 31 ]. Underweight children significantly poorer on power items than TD peers [ 32 ]. The English manual has been translated for use in local languages. Moderate correlations between PERF-FIT items and BOT-2 and MABC-2 balance items [ 27 ]. Moderate to high correlations between PERF-FIT items and exergames [ 33 ]. PERF-FIT ball skill items correlate moderately with BOT-2 ball skill items, but weakly with MABC-2 items [ 28 ]. Legend : CoV: coefficient of variation; TD: typically developing. *New results Data Analysis Descriptive statistics summarized demographic data, including age, weight, height, BMI, sex, and area. Raw PERF-FIT scores were examined for missing data and outliers. Q-Q plots indicated approximate normality for Power and Agility subscale items, while Motor Skill Performance subscale items exhibited increasing skewness with age, particularly for balance tasks. Differences in raw scores by age group and sex were analyzed using ANOVA with Bonferroni corrections. Effect sizes (η²) were interpreted as small (0.01–0.059), medium (0.06–0.13), or large (≥ 0.14) [ 34 ]. Internal consistency was assessed using Cronbach’s Alpha. Development of Reference Norms Raw scores were transformed into z-scores per age group and sex, following a Standard Normal Distribution (mean = 0, SD = 1). Z-scores for items where lower scores indicated better performance (e.g., running and stepping) were reversed. Outliers (± 4 SD) were excluded. Z-scores allow for comparisons across items and age groups by standardizing scores to a common scale. Z-scores were further converted into scale scores (range: 1–19; mean = 10, SD = 3) and percentiles. Scale scores were used to classify motor skill levels: typical development (8–12), below average (5–7), and definite difficulties (≤ 4). Percentiles were calculated for clinical interpretation, providing a measure of relative position within the reference group. All analyses were performed using SPSS (version 29.0; IBM Corp., Armonk, NY) at a significance level of p < 0.05. Population The entire sample consisted of 2,884 children, Nigeria (n = 336, 11.7%) and Ghana (n = 511, 17.7%), Ethiopia (n = 379, 13.1, Tunisia (251, 8.7), and South Africa (n = 1407, 48.8%). Of the total sample the data of 67 5-year-old children (2.3%) were excluded due to low participation numbers. Moreover, 119 (4.1%) were excluded because of thinness level 3 (17 of which were 5 years old) and 111 (3.8%) because of obesity. The PERF-FIT results of the remaining 2604 children (BMI, mean: 16.13, SD: 2.34) were used to calculate norm scores. This sample consisted of 21.1% children who were underweight, 67.9% having normal weight, and 11.0% overweight. Both sexes were represented equally: half boys (49.8%) and half girls (50.2%). The age range of the norm sample was 6-12y (mean: 8.7y, SD:1.8). The age distribution per sex is shown in Table 3 . Table 3 Description of the sample. Boys Girls Years Frequency $ Percentage Frequency $ Percentage 6 132 10.2 142 10.9 7 277 21.3 253 19.4 8 257 19.8 244 18.7 9 208 16.0 215 16.5 10 196 15.1 199 15.2 11 146 11.2 160 12.3 12 82 6.3 93 7.1 Total 1298 100.0 1306 100.0 Ethiopia Ghana Nigeria South Africa Tunisia Boys/girls $ 149/117 237/242 147/153 641/668 124/126 Age (years)* 6.8 (0.5) 9.81 (1.8) 8.2 (1.5) 9.5 (1.7) 8.5 (1.5) BMI (kg/m²)* 13.80 (1.26) 16.35 (2.34) 15.31 (2.19) 16.52 (2.27) 17.14 (1.89) Height (m)* 1.17 (0.08) 1.38 (0.12) 1.27 (0.10) 1.34 (0.11) 1.30 (0.09) Weight (kg)* 19.1 (2.46) 31.73 (8.54) 24.97 (6.62) 30.22 (8.06) 29.13 (6.13) Legend : $ number of children; * mean (SD) Age and sex-based effects A significant large age effect was observed across all PERF-FIT items (p < 0.001), except for static balance, which showed a medium sized effect (Table 4 ). Figure 1 illustrates the magnitude of age differences in effect sizes. Pairwise comparisons between consecutive age groups revealed significant differences (p < 0.01 after Bonferroni correction) for each comparison except Running 11–12, Stepping 6–7, 9–10, 11–12, Side jump 6–7, Long jump 10–11, Bounce and catch, and Throw and catch, 11–12, Static balance 8–9, 9–10, 11–12, Dynamic balance 8–9, 9–10, 11–12, Jumping and Hopping 7–8, 10–11 and 11-12years. Sex-based effects were also observed, with the direction of effects varying by task. Boys outperformed girls in upper and lower extremity power tasks and ball-related items, while girls excelled in side jump and balance tasks. However, these sex-based differences had small effect sizes (Table 4 ). Table 4 Age and Sex Effects on the 10 PERF-FIT Items. MAIN EFFECT AGE MAIN EFFECT SEX INTERACTION EFFECT RUNNING F 6,2581 = 272.962, p < 0.001 ; η²=0.388 F 1,2581 = 5.447, p = 0.020 ; η²=0.002 F 6,2581 = 0.485, p = 0.820; η²=0.001 STEPPING F 6,2566 = 266.265, p < 0.001 ; η²=0.384 F 1,2566 = 1.318, p = 0.251; η²=0.001 F 6,2566 = 0.672, p = 0.673; η²=0.002 SIDE JUMP F 6,2557 = 346.015, p < 0.001 ; η²=0.448 F 1,2557 = 25.243, p < 0.001 ; η²=0.010 F 6,2557 = 0.484, p = 0.821; η²=0.001 LONG JUMP F 6,2583 = 215.595, p < 0.001 ; η²=0.334 F 1,2583 = 73.005, p < 0.001 ; η²=0.027 F 6,2583 = 1.913, p = 0.075; η²=0.004 OVERHEAD THROW F 6,2587 = 442.914, p < 0.001 ; η²=0.507 F 1,2587 = 67.964, p < 0.001 ; η²=0.026 F 6,2557 = 1.482, p = 0.180; η²=0.003 BOUNCE & CATCH F 6,2583 = 198.662, p < 0.001 ; η²=0.316 F 1,2583 = 39.662, p < 0.001 ; η²=0.015 F 6,2583 = 0.896, p = 0.497; η²=0.002 THROW & CATCH F 6,2583 = 194.539, p < 0.001 ; η²=0.311 F 1,2583 = 38.465, p < 0.001 ; η²=0.015 F 6,2583 = 2.071, p = 0.054 ; η²=0.005 STATIC BALANCE F 6,2562 = 41.666, p < 0.001 ; η²=0.089 F 1,2562 = 7.647, p = 0.006 ; η²=0.003 F 6,2562 = 2.405, p = 0.025 ; η²=0.006 DYNAMIC BALANCE F 6,2579 = 104.489, p < 0.001 ; η²=0.196 F 1,2579 = 5.386, p = 0.020 ; η²=0.002 F 6,2579 = 1.547, p = 0.159; η²=0.004 JUMPING & HOPPING F 6,2583 = 88.426, p < 0.001 ; η²=0.170 F 1,2583 = 0.998, p = 0.318; η²=0.000 F 6,2583 = 1.265, p = 0.270; η²=0.003 Legend : pink shaded cells indicate a difference in favor of girls; blue shaded cells indicate a difference in favor of boys. Reference Norms Age- and sex-specific norms, presented as scale scores per item, per subscale and for total scores, are provided in Appendix 6 and they can also be calculated via the applications Appendix 2–5 . Interpretation guidelines for these scale scores are outlined in Table 5 . Scale scores between 8–12 indicate typical development and scale scores of ≤ 4 point to definite motor difficulties. The age-and sex-specific normative data are exemplified through the side jump and dynamic balance item (the cans task) in Fig. 2 . Discussion Africa has the youngest and fastest-growing population in the world, yet no motor performance tests with reference norms for African school aged children were available prior to this study. This lack of standardized tools limits the early detection and intervention of motor deficits, particularly in low-resource settings. Recognizing this gap, we developed the Performance and Fitness (PERF-FIT) test battery— a contextually relevant, low-cost tool tailored to low-resource communities. This study aimed to provide age- and sex-specific motor skill and fitness reference norms for African children and validate the utility of the PERF-FIT in this context. Motor Performance in African Contexts Existing data on motor performance in African children often paints a conflicting picture, with higher-than-expected percentages of children classified as at risk or severely impaired when assessed using Western-based tools like the Movement Assessment Battery Children, 2nd edition (MABC-2) or Bruininks-Oseretsky Test, 2nd edition (BOT-2) [ 35 – 40 ]. These findings highlight the inadequacy of applying norms from Western populations to African contexts [ 40 , 41 ]. Commercial tools are also prohibitively expensive for widespread use in low-resource areas [ 15 ], further emphasizing the need for accessible and culturally appropriate assessments. The PERF-FIT was designed to address these challenges, offering a freely available, reliable, and valid tool that requires minimal resources. The normative data generated in this study provide an appropriate benchmark for assessing motor performance in African children and monitoring changes over time. Age and Sex Effects Our findings confirm the necessity of age- and sex-specific norms for motor performance assessments. Age differences were highly significant for all components of the PERF-FIT, underscoring the importance of accounting for developmental progress in motor skills and fitness. Although sex differences were small, they were task-dependent: boys outperformed girls in tasks involving upper and lower extremity power and ball skills, while girls excelled in agility and balance tasks, which is consistent with literature trends [ 42 ]. Despite the small effect sizes, we opted to present sex-specific norms to minimize the risk of misclassification, particularly in clinical or educational settings. Implications for Clinical Use The age- and sex-specific norms presented in this study represent a significant step forward in the assessment of motor skills and fitness in African children. Scale score or percentile-based evaluations allow clinicians and educators to identify children at risk of motor deficits or fitness concerns. For instance, children scoring below the 5th percentile may require further evaluation or targeted intervention. At the group level, these norms can guide policy and practice, such as designing interventions to improve physical activity opportunities in schools or communities. By identifying specific areas of need, schools can introduce active recess initiatives or create safe spaces for active play. Similar to identifying children with other existing pediatric motor skill assessment tools [ 15 ], individualized or small-group interventions can be developed to address specific deficits in children consistently scoring in the impaired range. Psychometric Properties of PERF-FIT The PERF-FIT test battery was rigorously evaluated against the Consensus-based Standards for the selection of health Measurement Instruments [ 43 ]. Studies of its psychometric properties demonstrated high inter-rater reliability, test-retest stability, and strong content validity, with tasks reflecting culturally relevant activities and daily physical demands [ 16 – 18 , 23 , 24 , 26 – 32 ]. While criterion validity could not be directly established due to the lack of comparable tools in African populations, the PERF-FIT showed moderate correlations with existing tools used in other contexts [ 27 , 28 , 33 ]. These findings underscore the robustness of the PERF-FIT as a valid and reliable assessment tool (see Table 2 ). Limitations and Future Directions Although the PERF-FIT norms were developed from a large and representative sample, the exclusion of children with severe underweight and obesity limits their applicability to extreme BMI categories. Underweight remains highly prevalent in parts of Africa, and further research is needed to explore the impact of weight on outcomes in these populations. Additionally, ceiling effects were observed in some items, particularly balance tasks, among older children. However, this is consistent with similar motor performance tests developed in Western countries like the MABC-2 and BOT-2. Future studies should explore adaptations to reduce ceiling effects and evaluate the applicability of PERF-FIT norms in other populations and age groups (5-year-olds). Conclusion This study provides the first age- and sex-specific motor skill norms for African children aged 6–12 using the newly developed PERF-FIT test battery. The results highlight the importance of contextually relevant assessment tools in addressing motor deficits and guiding interventions in low-resource settings. By establishing robust psychometric properties and generating normative data, the PERF-FIT is positioned as a critical resource for clinicians, educators, and policymakers working to improve motor performance and physical fitness among African children. Declarations Training videos are available via the first author. Author contributions: BSE: Conceptualize the idea, designed to overall study, analyzed the data, wrote the first draft of the paper, supervised local project leaders. DC, RX, OI, FF, YD: Local project leaders: Supervised the local data collection in their country, obtained ethics, trained assessors, entered data, reviewed the draft of the paper. EV supervised local project leaders, developed training materials, analyzed the data, edited the final version of the paper. Acknowledgements. We acknowledge the support of parents, children, and management of the participating schools. Special thanks to the teams which helped out with the pilot studies (dr Gillian Ferguson, dr. Dorothee Jelsma, dr. Tatiane Targino Gomes Draghi, dr. Jorge Cavalcante Neto) and all volunteers who helped collecting data, translate materials, enter data. We also thank Ramous Azawornu (online tool) and Mark van Steen (Excel) for developing the applications for scoring. References https://diabetesatlas.org/data/en/indicators/22/. https://www.un.org/africarenewal/magazine/december-2016-march-2017/health-care-commitments-action. Bhuiyan MA, Galdes N, Cuschieri S, Hu P. 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Acta Gymnica. 2017;47:193-200. Smits-Engelsman B, Verbecque E, Denysschen M, Coetzee D. Exploring Cultural Bias in Two Different Motor Competence Test Batteries When Used in African Children. Int J Environ Res Public Health. 2022;19. Tsiotra GD, Flouris AD, Koutedakis Y, Faught BE, Nevill AM, Lane AM, et al. A comparison of developmental coordination disorder prevalence rates in Canadian and Greek children. J Adolesc Health. 2006;39:125-7. Verbecque E, Denysschen M, Coetzee D, Valtr L, Bonney E, Smits-Engelsman B. Which items of the movement assessment battery for children are most sensitive for identifying children with probable developmental coordination disorder? Results from a large-scale study. Res Dev Disabil. 2025;157:104904. Valentini NC, Nobre GC, Gonçalves Duarte M. Gross motor skills trajectory variation between WEIRD and LMIC countries: A cross-cultural study. PLoS One. 2022;17:e0267665. Barnett LM, Lai SK, Veldman SLC, Hardy LL, Cliff DP, Morgan PJ, et al. Correlates of Gross Motor Competence in Children and Adolescents: A Systematic Review and Meta-Analysis. Sports Med. 2016;46:1663-88. Mokkink LB, de Vet HCW, Prinsen CAC, Patrick DL, Alonso J, Bouter LM, et al. COSMIN Risk of Bias checklist for systematic reviews of Patient-Reported Outcome Measures. Qual Life Res. 2018;27:1171-9. Additional Declarations There is NO Competing Interest. Supplementary Files Appendix1ManualPerffitt2.5.pdf Manual PERF-FIT Appendix2IntructionsforscoringthePERFFITusingtheapp.pdf Scoring instruction for using the online application to look up scale scores Appendix3InstructionsforscoringthePERFFITusingexcel.pdf Scoring instruction for excel Appendix4ScoreformPERFFITWindows.xlsx Supplementary Dataset 1 Appendix5ScoreformPERFFITMac.xlsx Supplementary Dataset 2 Appendix6PERFFITTWorkBookLookupscalescores.xlsx Supplementary Dataset 3 Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6033383","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":421795504,"identity":"779c2126-fd84-476f-826b-7fba4c8dc079","order_by":0,"name":"Bouwien Smits-Engelsman","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA70lEQVRIiWNgGAWjYBACAxCRACKYgfhjA4jF2HiASC3MDIwzGxgkgFoaCGuBAGYGZl6wFgYGvFrM2XvMJB5U3LHXbec//Nl2h02dbvthoC01NtG4tFj2nDGTSDjzLHHbYWY26dwzaRJmZxKBWo6l5TbgctiNHLMbiW2HE8yAWphz2w5LmB0AamFsOExAy7/D9kAtzJ8tQVrOPyRGS8NhRqDDGKQZQVpuELDFsudY+Y+EY4dBfjGT7G1Lk9x2A2hLAh6/mLM3bzb8UQN02PmDjz/8bLPhNzuf/vDBhxobnFpwgATSlI+CUTAKRsEoQAMAEB5kIJRV7DcAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0003-0632-3276","institution":"North West University","correspondingAuthor":true,"prefix":"","firstName":"Bouwien","middleName":"","lastName":"Smits-Engelsman","suffix":""},{"id":421795505,"identity":"8997f795-bc2c-478d-99d5-4995ff50b210","order_by":1,"name":"Dane Coetzee","email":"","orcid":"","institution":"North West University","correspondingAuthor":false,"prefix":"","firstName":"Dane","middleName":"","lastName":"Coetzee","suffix":""},{"id":421795506,"identity":"b351e6ad-bf1c-499a-82a9-468531bbc8c3","order_by":2,"name":"Rosemary Doe-Asinyo","email":"","orcid":"https://orcid.org/0000-0003-1766-8173","institution":"College of Health Sciences, University of Ghana, Accra, Ghana.","correspondingAuthor":false,"prefix":"","firstName":"Rosemary","middleName":"","lastName":"Doe-Asinyo","suffix":""},{"id":421795507,"identity":"19bc75d8-f4fa-49c7-9b80-c27434a10cec","order_by":3,"name":"Oluwakemi Ituen","email":"","orcid":"","institution":"University of Uyo Teaching Hospital,","correspondingAuthor":false,"prefix":"","firstName":"Oluwakemi","middleName":"","lastName":"Ituen","suffix":""},{"id":421795508,"identity":"ca3351e5-2dfe-413e-bebe-4c07ace03707","order_by":4,"name":"Faical Farhat","email":"","orcid":"","institution":"University of Gafsa","correspondingAuthor":false,"prefix":"","firstName":"Faical","middleName":"","lastName":"Farhat","suffix":""},{"id":421795509,"identity":"7e965e95-35c5-4dca-b018-1006b98f9301","order_by":5,"name":"Yabsra Dubale","email":"","orcid":"","institution":"Jimma University,","correspondingAuthor":false,"prefix":"","firstName":"Yabsra","middleName":"","lastName":"Dubale","suffix":""},{"id":421795510,"identity":"ab84e55e-896c-4618-acf2-9cd218f12c76","order_by":6,"name":"Evi Verbecque","email":"","orcid":"","institution":"University of Hasselt","correspondingAuthor":false,"prefix":"","firstName":"Evi","middleName":"","lastName":"Verbecque","suffix":""}],"badges":[],"createdAt":"2025-02-14 22:10:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6033383/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6033383/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":77394367,"identity":"4c5789b2-a2f7-4006-a186-3805f84c2d9c","added_by":"auto","created_at":"2025-02-28 07:10:09","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":25999,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eEffect sizes of the age effects per item.\u003c/strong\u003eLine indicates η² ≥0.14 or large effect size.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6033383/v1/fcbbe0f9da0ae1c699619f98.png"},{"id":77393361,"identity":"03cecdfe-5ee8-4872-9226-93ce3001bcde","added_by":"auto","created_at":"2025-02-28 07:02:09","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":60186,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eExample of the percentile curves for the 5\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003eth\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e, 15\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003eth\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e, 50\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003eth\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e, and 85\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003eth\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e percentiles for side jump (upper) and cans task (lower) across different age groups for boys (left) and girls (right).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNote: 1) Upper left and right figures: The number of side jumps in 15 seconds increases significantly with increasing age in both boys and girls. Girls outperform boys in each age band. 2) Lower left and right figures: a clear ceiling effect is visible for the children with good perfomances (percentile curve 50 and 85), whereas those with lower scores improve with increasing age.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6033383/v1/ca8ae81059db89c943f7144e.png"},{"id":80152703,"identity":"6cc9bd0b-d848-4791-b50d-af93b842885a","added_by":"auto","created_at":"2025-04-08 13:45:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":995345,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6033383/v1/2af65e7b-ff88-4278-b10f-cacd9da938a0.pdf"},{"id":77394369,"identity":"05bd62cf-ea17-4971-8254-86fa54c46917","added_by":"auto","created_at":"2025-02-28 07:10:09","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":1221769,"visible":true,"origin":"","legend":"\u003cp\u003eManual PERF-FIT\u003c/p\u003e","description":"","filename":"Appendix1ManualPerffitt2.5.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6033383/v1/1bb18df745f58cfcbff460ec.pdf"},{"id":77393367,"identity":"9c3da847-d085-460d-be85-b20611ea2dd5","added_by":"auto","created_at":"2025-02-28 07:02:09","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":205467,"visible":true,"origin":"","legend":"Scoring instruction for using the online application to look up scale scores","description":"","filename":"Appendix2IntructionsforscoringthePERFFITusingtheapp.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6033383/v1/f427f5fa7276d80e2f8b79b3.pdf"},{"id":77394539,"identity":"d589702a-20c8-4d85-9551-951e0817e156","added_by":"auto","created_at":"2025-02-28 07:18:11","extension":"pdf","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":555584,"visible":true,"origin":"","legend":"Scoring instruction for excel","description":"","filename":"Appendix3InstructionsforscoringthePERFFITusingexcel.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6033383/v1/d2ce0dcb173e8a3833562f0f.pdf"},{"id":77394537,"identity":"6132007d-2f94-4841-b5fc-367d05e814f9","added_by":"auto","created_at":"2025-02-28 07:18:09","extension":"xlsx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":6815897,"visible":true,"origin":"","legend":"\u003cp\u003eSupplementary Dataset 1\u003c/p\u003e","description":"","filename":"Appendix4ScoreformPERFFITWindows.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-6033383/v1/71044ddce9427bb5e4945ffd.xlsx"},{"id":77393377,"identity":"c9bfa7f4-82c3-44d0-a1ff-4aaa06920d7e","added_by":"auto","created_at":"2025-02-28 07:02:09","extension":"xlsx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":6811250,"visible":true,"origin":"","legend":"\u003cp\u003eSupplementary Dataset 2\u003c/p\u003e","description":"","filename":"Appendix5ScoreformPERFFITMac.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-6033383/v1/643021df97d0c348245135d3.xlsx"},{"id":77393376,"identity":"0e9c9b81-2e39-4753-bbf4-77208b57c415","added_by":"auto","created_at":"2025-02-28 07:02:09","extension":"xlsx","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":78004,"visible":true,"origin":"","legend":"Supplementary Dataset 3","description":"","filename":"Appendix6PERFFITTWorkBookLookupscalescores.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-6033383/v1/302e76a35a571e5f6f391533.xlsx"}],"financialInterests":"There is \u003cb\u003eNO\u003c/b\u003e Competing Interest.","formattedTitle":"Motor skills and fitness in African children: the PERF-FIT study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAfrica is home to the world\u0026rsquo;s largest child population, yet it bears a disproportionate burden of health challenges [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. According to the World Health Organization (WHO), the continent accounts for 25% of the global disease burden but receives less than 1% of worldwide health expenditures [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. One of the growing concerns in Africa is the increasing prevalence of non-communicable diseases (NCDs), due to shifts in lifestyle and dietary habits [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Early intervention, particularly through promoting physical activity and active lifestyles among children, has emerged as a key strategy in preventing NCDs and fostering long-term health [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. A critical yet often overlooked factor in engaging children in physical activity is their motor skill proficiency [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Children with well-developed motor skills are more likely to participate in physical activities, while those who face developmental delays in motor coordination are less inclined to engage in physical play and sports [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This lack of activity can ultimately lead to lower fitness levels, which is a primary risk factor for NCDs [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile much of the focus on physical activity has centered on promoting exercise in adult populations, less attention has been given to the critical role motor skill development plays in shaping children\u0026rsquo;s long-term engagement with physical activity, particularly in Africa [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Early development of motor skills not only enhances children's ability to engage in physical activity but also plays a fundamental role in their overall health, cognitive development, and social integration [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Unfortunately, children in many African countries face significant barriers to developing these essential motor skills [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNot all children develop motor skills at the same rate, and various factors such as developmental disorders, HIV, sickle cell disease, and environmental constraints can further hinder motor development in many African children [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Unfortunately, the lack of standardized, contextually relevant assessments makes it difficult to identify motor delays early. While several motor performance tests exist, most are not designed for African children and lack valid norms for those aged 6\u0026ndash;12 [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo address this gap, we have developed the PERFormance and FITness test battery (PERF-FIT)\u0026mdash;a motor performance tool specifically designed for low-resource African settings. The PERF-FIT provides a set of reliable [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], feasible [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], and culturally relevant items [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] that healthcare professionals and educators can use to evaluate motor skill development and fitness in children aged 6\u0026ndash;12. Developed with input from experts in child development and human movement science [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], it assesses key motor aspects such as agility, balance, coordination, power, and speed\u0026mdash;all essential for fostering physical activity.\u003c/p\u003e \u003cp\u003eEnabled by a large team of volunteers and developed in collaboration with experts from local African universities, this test provides an accessible, free tool for assessing motor skills and guiding interventions. This initiative filled the gap, offering a crucial resource for health professionals, educators, and policymakers. Our hope is that this tool will empower communities across Africa to take proactive steps towards improving children\u0026rsquo;s physical health, and by extension, their future well-being.\u003c/p\u003e \u003cp\u003eBy providing a contextually relevant tool that is both free and open-source, we aim to contribute to the United Nations\u0026rsquo; Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being) and SDG 4 (Quality Education), while promoting a more equitable approach to addressing health disparities among African children [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis paper aims to establish normative data for the PERF-FIT test battery that are both age- and sex-appropriate for African children. By providing these norms, we aim to give clinicians and educators a powerful tool to identify children at risk for motor delays and low fitness, enabling early intervention that can help improve physical health outcomes and support the adoption of active lifestyles.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eSelection of Participants\u003c/p\u003e \u003cp\u003eData were collected across diverse regions of Africa with large and growing populations (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Specifically, data were sampled from Nigeria and Ghana in West Africa, Ethiopia in East Africa, Tunisia in North Africa (replacing Sudan due to the conflict), and South Africa in Southern Africa. Efforts were made to include participants from both rural and urban areas. Ethical approval and informed consent were obtained before testing, resulting in a final sample of 2,884 African children.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOverview of African Regions with Large Growing Populations [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage of Africa\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal Population\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePercentage Growth\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNorth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSudan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50,042,791\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.34%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTunisia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12,200,431\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.67%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEast\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e128,691,692\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.64%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWest\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNigeria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e227,882,945\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.12%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGhana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33,787,914\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.93%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSouth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSouth Africa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e63,212,384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.34%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \n\u003cp\u003eStudy Procedure\u003c/p\u003e \n\u003cp\u003eThis cross-sectional study was conducted between 2019 and September 2024. All data were anonymized and analyzed using unique ID numbers. Ethical approvals were granted by the respective Human Research Ethics Committees (South Africa: HREC REF: 139/2019, HREC REF: 112/2020, NWU 00491-19-A1; Tunisia: CPP SUD N\u0026deg; 0301/2021; Ghana: GHS-ERC 052/05/19; Nigeria: UUTH/AD/S/96/VOL/XXI/524; Ethiopia: JUIH/IRB/691/23). Permission was also obtained from local education authorities and school administrations. Written informed consent was secured from parents, while children provided assent. All procedures adhered to the World Medical Association Declaration of Helsinki [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe PERF-FIT test battery was administered by trained investigators who followed standardized protocols. Training included reading the manual, practicing with both typically developing children and those with neurodevelopmental disorders, and receiving feedback on recorded or live demonstrations. Only after successful evaluations were investigators cleared to conduct testing. All testing occurred in small groups at schools, with children generally wearing school uniforms and performing barefoot due to the lack of appropriate footwear.\u003c/p\u003e \u003cp\u003eMaterials\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDemographic and Anthropometric Data\u003c/h2\u003e \u003cp\u003eDemographic data included age, sex, country, and location (urban/rural). Height was measured using a steel tape measure mounted on a wall, and weight was recorded using an electronic scale, both without shoes and in light clothing. Body mass index (BMI) was calculated as weight (kg) divided by height squared (m\u0026sup2;). Children were classified into BMI categories based on International Obesity Task Force (IOTF) criteria [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]: thinness grades 1\u0026ndash;3, normal weight, overweight, and obese.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePERF-FIT Test Battery\u003c/h3\u003e\n\u003cp\u003eThe PERF-FIT test battery targets children aged 5\u0026ndash;12 years, including those suspected of low motor skills or fitness. It was designed to:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eBe culturally feasible for children aged 5\u0026ndash;12 years.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eCover all aspects of motor skill-related fitness.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eRequire no expensive materials or specific space.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThe test comprises 10 items divided into two subscales: the \u003cem\u003ePower and Agility Subscale\u003c/em\u003e (running, stepping, side jump, long jump, and overhead throw) and the \u003cem\u003eMotor Skill Performance Subscale\u003c/em\u003e (bouncing and catching, throwing and catching, jumping and hopping, static balance, and dynamic balance tasks). Each item is described in detail in the manual (\u003cb\u003eAppendix 1\u003c/b\u003e). The test has a maximum administration time of 40 minutes. Scoring can be done using applications (\u003cb\u003eAppendix 2\u0026ndash;4\u003c/b\u003e). The test has been validated for excellent content validity, good structural validity, high inter-rater reliability (ICC\u0026thinsp;=\u0026thinsp;0.99), and good test-retest reliability (ICC\u0026thinsp;=\u0026thinsp;0.80) [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarizes the psychometric characteristics.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eSummary of the psychometric properties of the PERF-FIT.\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eRELIABILITY\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRESPONSIVENESS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eInternal consistency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInterrater reliability\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTest-retest reliability\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCronbach\u0026rsquo;s Alpha 0.74*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eICC\u0026thinsp;=\u0026thinsp;0.99 [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eICC\u0026thinsp;\u0026gt;\u0026thinsp;0.80\u003c/p\u003e \u003cp\u003eCoV: 0\u0026ndash;20% (excellent to good precision) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChildren with DCD: Medium-to-large effect sizes for all PERF-FIT items, except throw \u0026amp; catch, after a Wii-fit intervention (12 weeks, 3x/week) [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Medium effect sizes for the PERF-FIT stepping and side jump items after Wii-fit/Kinect training (5 weeks, 1-2x/week) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Large effects sizes on all PERF-FIT items after a task-oriented basketball-related training intervention [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eChildren with moderate thinness: Large improvements after active play intervention (12 weeks, 5x/week) on the stepping, side jump, long jump, bounce \u0026amp; catch, throw \u0026amp; catch and jumping \u0026amp; hopping [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVALIDITY\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eContent\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eConstruct validity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eCriterion/ concurrent\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eStructural\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eHypothesis testing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eCross-cultural\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCVI score of 0.99 [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate correlations among balance PERF-FIT balance items [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Balance items load on one component indicating the same construct [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. PERF-FIT ball skill items correlate strongly with each other and moderately with the overhead throw [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The PERF-FIT ball skill items load on another component than the Overhead throw, supporting the distinct construct they cover [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChildren with DCD: severe DCD significantly poorer on the PERF-FIT bounce \u0026amp; catch, throw \u0026amp; catch and overhead throw items than moderate DCD, who perform significantly poorer than TD peers [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The PERF-FIT is moderately associated with the DCDDaily questionnaire total score and daily participation subscore [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Malnourished children: overweight children significantly poorer on static and dynamic balance tasks than normal weight peers [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Underweight children significantly poorer on power items than TD peers [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe English manual has been translated for use in local languages.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate correlations between PERF-FIT items and BOT-2 and MABC-2 balance items [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Moderate to high correlations between PERF-FIT items and exergames [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePERF-FIT ball skill items correlate moderately with BOT-2 ball skill items, but weakly with MABC-2 items [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLegend\u003c/b\u003e: CoV: coefficient of variation; TD: typically developing. *New results\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics summarized demographic data, including age, weight, height, BMI, sex, and area. Raw PERF-FIT scores were examined for missing data and outliers. Q-Q plots indicated approximate normality for Power and Agility subscale items, while Motor Skill Performance subscale items exhibited increasing skewness with age, particularly for balance tasks.\u003c/p\u003e \u003cp\u003eDifferences in raw scores by age group and sex were analyzed using ANOVA with Bonferroni corrections. Effect sizes (η\u0026sup2;) were interpreted as small (0.01\u0026ndash;0.059), medium (0.06\u0026ndash;0.13), or large (\u0026ge;\u0026thinsp;0.14) [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Internal consistency was assessed using Cronbach\u0026rsquo;s Alpha.\u003c/p\u003e \u003cp\u003eDevelopment of Reference Norms\u003c/p\u003e \u003cp\u003eRaw scores were transformed into z-scores per age group and sex, following a Standard Normal Distribution (mean\u0026thinsp;=\u0026thinsp;0, SD\u0026thinsp;=\u0026thinsp;1). Z-scores for items where lower scores indicated better performance (e.g., running and stepping) were reversed. Outliers (\u0026plusmn;\u0026thinsp;4 SD) were excluded. Z-scores allow for comparisons across items and age groups by standardizing scores to a common scale.\u003c/p\u003e \u003cp\u003eZ-scores were further converted into scale scores (range: 1\u0026ndash;19; mean\u0026thinsp;=\u0026thinsp;10, SD\u0026thinsp;=\u0026thinsp;3) and percentiles. Scale scores were used to classify motor skill levels: typical development (8\u0026ndash;12), below average (5\u0026ndash;7), and definite difficulties (\u0026le;\u0026thinsp;4). Percentiles were calculated for clinical interpretation, providing a measure of relative position within the reference group.\u003c/p\u003e \u003cp\u003eAll analyses were performed using SPSS (version 29.0; IBM Corp., Armonk, NY) at a significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003ePopulation\u003c/p\u003e \u003cp\u003eThe entire sample consisted of 2,884 children, Nigeria (n\u0026thinsp;=\u0026thinsp;336, 11.7%) and Ghana (n\u0026thinsp;=\u0026thinsp;511, 17.7%), Ethiopia (n\u0026thinsp;=\u0026thinsp;379, 13.1, Tunisia (251, 8.7), and South Africa (n\u0026thinsp;=\u0026thinsp;1407, 48.8%). Of the total sample the data of 67 5-year-old children (2.3%) were excluded due to low participation numbers. Moreover, 119 (4.1%) were excluded because of thinness level 3 (17 of which were 5 years old) and 111 (3.8%) because of obesity. The PERF-FIT results of the remaining 2604 children (BMI, mean: 16.13, SD: 2.34) were used to calculate norm scores. This sample consisted of 21.1% children who were underweight, 67.9% having normal weight, and 11.0% overweight. Both sexes were represented equally: half boys (49.8%) and half girls (50.2%). The age range of the norm sample was 6-12y (mean: 8.7y, SD:1.8). The age distribution per sex is shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescription of the sample.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eBoys\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eGirls\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFrequency\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e277\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e253\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1306\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eEthiopia\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eGhana\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eNigeria\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eSouth Africa\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eTunisia\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoys/girls\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e149/117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e237/242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e147/153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e641/668\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e124/126\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.8 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.81 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.2 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.5 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8.5 (1.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u0026sup2;)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.80 (1.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.35 (2.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.31 (2.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16.52 (2.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17.14 (1.89)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (m)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.17 (0.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.38 (0.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.27 (0.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.34 (0.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.30 (0.09)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (kg)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.1 (2.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.73 (8.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.97 (6.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.22 (8.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29.13 (6.13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLegend\u003c/b\u003e: \u003csup\u003e$\u003c/sup\u003e number of children; * mean (SD)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAge and sex-based effects\u003c/p\u003e \u003cp\u003eA significant large age effect was observed across all PERF-FIT items (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), except for static balance, which showed a medium sized effect (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the magnitude of age differences in effect sizes.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePairwise comparisons between consecutive age groups revealed significant differences (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01 after Bonferroni correction) for each comparison except Running 11\u0026ndash;12, Stepping 6\u0026ndash;7, 9\u0026ndash;10, 11\u0026ndash;12, Side jump 6\u0026ndash;7, Long jump 10\u0026ndash;11, Bounce and catch, and Throw and catch, 11\u0026ndash;12, Static balance 8\u0026ndash;9, 9\u0026ndash;10, 11\u0026ndash;12, Dynamic balance 8\u0026ndash;9, 9\u0026ndash;10, 11\u0026ndash;12, Jumping and Hopping 7\u0026ndash;8, 10\u0026ndash;11 and 11-12years.\u003c/p\u003e \u003cp\u003eSex-based effects were also observed, with the direction of effects varying by task. Boys outperformed girls in upper and lower extremity power tasks and ball-related items, while girls excelled in side jump and balance tasks. However, these sex-based differences had small effect sizes (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAge and Sex Effects on the 10 PERF-FIT Items.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMAIN EFFECT AGE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMAIN EFFECT SEX\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eINTERACTION EFFECT\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRUNNING\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003csub\u003e6,2581\u003c/sub\u003e= 272.962, \u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e; η\u0026sup2;=0.388\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003csub\u003e1,2581\u003c/sub\u003e= 5.447, \u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.020\u003c/b\u003e; η\u0026sup2;=0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003csub\u003e6,2581\u003c/sub\u003e= 0.485, p\u0026thinsp;=\u0026thinsp;0.820; η\u0026sup2;=0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSTEPPING\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003csub\u003e6,2566\u003c/sub\u003e= 266.265, \u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e; η\u0026sup2;=0.384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003csub\u003e1,2566\u003c/sub\u003e= 1.318, p\u0026thinsp;=\u0026thinsp;0.251; η\u0026sup2;=0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003csub\u003e6,2566\u003c/sub\u003e= 0.672, p\u0026thinsp;=\u0026thinsp;0.673; η\u0026sup2;=0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSIDE JUMP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003csub\u003e6,2557\u003c/sub\u003e= 346.015, \u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e; η\u0026sup2;=0.448\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003csub\u003e1,2557\u003c/sub\u003e= 25.243, \u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e; η\u0026sup2;=0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003csub\u003e6,2557\u003c/sub\u003e= 0.484, p\u0026thinsp;=\u0026thinsp;0.821; η\u0026sup2;=0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLONG JUMP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003csub\u003e6,2583\u003c/sub\u003e= 215.595, \u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e; η\u0026sup2;=0.334\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003csub\u003e1,2583\u003c/sub\u003e= 73.005, \u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e; η\u0026sup2;=0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003csub\u003e6,2583\u003c/sub\u003e= 1.913, p\u0026thinsp;=\u0026thinsp;0.075; η\u0026sup2;=0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOVERHEAD THROW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003csub\u003e6,2587\u003c/sub\u003e= 442.914, \u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e; η\u0026sup2;=0.507\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003csub\u003e1,2587\u003c/sub\u003e= 67.964, \u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e; η\u0026sup2;=0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003csub\u003e6,2557\u003c/sub\u003e= 1.482, p\u0026thinsp;=\u0026thinsp;0.180; η\u0026sup2;=0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBOUNCE \u0026amp; CATCH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003csub\u003e6,2583\u003c/sub\u003e= 198.662, \u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e; η\u0026sup2;=0.316\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003csub\u003e1,2583\u003c/sub\u003e= 39.662, \u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e; η\u0026sup2;=0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003csub\u003e6,2583\u003c/sub\u003e= 0.896, p\u0026thinsp;=\u0026thinsp;0.497; η\u0026sup2;=0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTHROW \u0026amp; CATCH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003csub\u003e6,2583\u003c/sub\u003e= 194.539, \u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e; η\u0026sup2;=0.311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003csub\u003e1,2583\u003c/sub\u003e= 38.465, \u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e; η\u0026sup2;=0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003csub\u003e6,2583\u003c/sub\u003e= 2.071, \u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.054\u003c/b\u003e; η\u0026sup2;=0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSTATIC BALANCE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003csub\u003e6,2562\u003c/sub\u003e= 41.666, \u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e; η\u0026sup2;=0.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003csub\u003e1,2562\u003c/sub\u003e= 7.647, \u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.006\u003c/b\u003e; η\u0026sup2;=0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003csub\u003e6,2562\u003c/sub\u003e= 2.405, \u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.025\u003c/b\u003e; η\u0026sup2;=0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDYNAMIC BALANCE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003csub\u003e6,2579\u003c/sub\u003e= 104.489, \u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e; η\u0026sup2;=0.196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003csub\u003e1,2579\u003c/sub\u003e= 5.386, \u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.020\u003c/b\u003e; η\u0026sup2;=0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003csub\u003e6,2579\u003c/sub\u003e= 1.547, p\u0026thinsp;=\u0026thinsp;0.159; η\u0026sup2;=0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJUMPING \u0026amp; HOPPING\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003csub\u003e6,2583\u003c/sub\u003e= 88.426, \u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e; η\u0026sup2;=0.170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003csub\u003e1,2583\u003c/sub\u003e= 0.998, p\u0026thinsp;=\u0026thinsp;0.318; η\u0026sup2;=0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003csub\u003e6,2583\u003c/sub\u003e= 1.265, p\u0026thinsp;=\u0026thinsp;0.270; η\u0026sup2;=0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLegend\u003c/b\u003e: pink shaded cells indicate a difference in favor of girls; blue shaded cells indicate a difference in favor of boys.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eReference Norms\u003c/p\u003e \u003cp\u003eAge- and sex-specific norms, presented as scale scores per item, per subscale and for total scores, are provided in \u003cb\u003eAppendix 6\u003c/b\u003e and they can also be calculated via the applications \u003cb\u003eAppendix 2\u0026ndash;5\u003c/b\u003e. Interpretation guidelines for these scale scores are outlined in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. Scale scores between 8\u0026ndash;12 indicate typical development and scale scores of \u0026le;\u0026thinsp;4 point to definite motor difficulties. The age-and sex-specific normative data are exemplified through the side jump and dynamic balance item (the cans task) in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \n\u003cp\u003e\u003cimg 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\" height=\"265\" width=\"581\"\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAfrica has the youngest and fastest-growing population in the world, yet no motor performance tests with reference norms for African school aged children were available prior to this study. This lack of standardized tools limits the early detection and intervention of motor deficits, particularly in low-resource settings. Recognizing this gap, we developed the Performance and Fitness (PERF-FIT) test battery\u0026mdash; a contextually relevant, low-cost tool tailored to low-resource communities. This study aimed to provide age- and sex-specific motor skill and fitness reference norms for African children and validate the utility of the PERF-FIT in this context.\u003c/p\u003e \u003cp\u003eMotor Performance in African Contexts\u003c/p\u003e \u003cp\u003eExisting data on motor performance in African children often paints a conflicting picture, with higher-than-expected percentages of children classified as at risk or severely impaired when assessed using Western-based tools like the Movement Assessment Battery Children, 2nd edition (MABC-2) or Bruininks-Oseretsky Test, 2nd edition (BOT-2) [\u003cspan additionalcitationids=\"CR36 CR37 CR38 CR39\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. These findings highlight the inadequacy of applying norms from Western populations to African contexts [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Commercial tools are also prohibitively expensive for widespread use in low-resource areas [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], further emphasizing the need for accessible and culturally appropriate assessments. The PERF-FIT was designed to address these challenges, offering a freely available, reliable, and valid tool that requires minimal resources. The normative data generated in this study provide an appropriate benchmark for assessing motor performance in African children and monitoring changes over time.\u003c/p\u003e \u003cp\u003eAge and Sex Effects\u003c/p\u003e \u003cp\u003eOur findings confirm the necessity of age- and sex-specific norms for motor performance assessments. Age differences were highly significant for all components of the PERF-FIT, underscoring the importance of accounting for developmental progress in motor skills and fitness. Although sex differences were small, they were task-dependent: boys outperformed girls in tasks involving upper and lower extremity power and ball skills, while girls excelled in agility and balance tasks, which is consistent with literature trends [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Despite the small effect sizes, we opted to present sex-specific norms to minimize the risk of misclassification, particularly in clinical or educational settings.\u003c/p\u003e \u003cp\u003eImplications for Clinical Use\u003c/p\u003e \u003cp\u003eThe age- and sex-specific norms presented in this study represent a significant step forward in the assessment of motor skills and fitness in African children. Scale score or percentile-based evaluations allow clinicians and educators to identify children at risk of motor deficits or fitness concerns. For instance, children scoring below the 5th percentile may require further evaluation or targeted intervention. At the group level, these norms can guide policy and practice, such as designing interventions to improve physical activity opportunities in schools or communities. By identifying specific areas of need, schools can introduce active recess initiatives or create safe spaces for active play. Similar to identifying children with other existing pediatric motor skill assessment tools [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], individualized or small-group interventions can be developed to address specific deficits in children consistently scoring in the impaired range.\u003c/p\u003e \u003cp\u003ePsychometric Properties of PERF-FIT\u003c/p\u003e \u003cp\u003eThe PERF-FIT test battery was rigorously evaluated against the Consensus-based Standards for the selection of health Measurement Instruments [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Studies of its psychometric properties demonstrated high inter-rater reliability, test-retest stability, and strong content validity, with tasks reflecting culturally relevant activities and daily physical demands [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan additionalcitationids=\"CR27 CR28 CR29 CR30 CR31\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. While criterion validity could not be directly established due to the lack of comparable tools in African populations, the PERF-FIT showed moderate correlations with existing tools used in other contexts [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. These findings underscore the robustness of the PERF-FIT as a valid and reliable assessment tool (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLimitations and Future Directions\u003c/p\u003e \u003cp\u003eAlthough the PERF-FIT norms were developed from a large and representative sample, the exclusion of children with severe underweight and obesity limits their applicability to extreme BMI categories. Underweight remains highly prevalent in parts of Africa, and further research is needed to explore the impact of weight on outcomes in these populations. Additionally, ceiling effects were observed in some items, particularly balance tasks, among older children. However, this is consistent with similar motor performance tests developed in Western countries like the MABC-2 and BOT-2. Future studies should explore adaptations to reduce ceiling effects and evaluate the applicability of PERF-FIT norms in other populations and age groups (5-year-olds).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides the first age- and sex-specific motor skill norms for African children aged 6\u0026ndash;12 using the newly developed PERF-FIT test battery. The results highlight the importance of contextually relevant assessment tools in addressing motor deficits and guiding interventions in low-resource settings. By establishing robust psychometric properties and generating normative data, the PERF-FIT is positioned as a critical resource for clinicians, educators, and policymakers working to improve motor performance and physical fitness among African children.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eTraining videos are available via the first author.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAuthor contributions:\u003c/h2\u003e \u003cp\u003eBSE: Conceptualize the idea, designed to overall study, analyzed the data, wrote the first draft of the paper, supervised local project leaders. DC, RX, OI, FF, YD: Local project leaders: Supervised the local data collection in their country, obtained ethics, trained assessors, entered data, reviewed the draft of the paper. EV supervised local project leaders, developed training materials, analyzed the data, edited the final version of the paper.\u003c/p\u003e\u003ch2\u003eAcknowledgements.\u003c/h2\u003e \u003cp\u003eWe acknowledge the support of parents, children, and management of the participating schools. Special thanks to the teams which helped out with the pilot studies (dr Gillian Ferguson, dr. Dorothee Jelsma, dr. Tatiane Targino Gomes Draghi, dr. Jorge Cavalcante Neto) and all volunteers who helped collecting data, translate materials, enter data. We also thank Ramous Azawornu (online tool) and Mark van Steen (Excel) for developing the applications for scoring.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ehttps://diabetesatlas.org/data/en/indicators/22/.\u003c/li\u003e\n\u003cli\u003ehttps://www.un.org/africarenewal/magazine/december-2016-march-2017/health-care-commitments-action.\u003c/li\u003e\n\u003cli\u003eBhuiyan MA, Galdes N, Cuschieri S, Hu P. 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Type of active video-games training does not impact the effect on balance and agility in children with and without developmental coordination disorder: A randomized comparator-controlled trial. Appl Neuropsychol Child. 2023;12:64-73.\u003c/li\u003e\n\u003cli\u003eFarhat F, Ammar A, Mezghani N, Kammoun MM, Trabelsi K, Gharbi A, et al. The effect of task-oriented basketball training on motor skill- related fitness in children with developmental coordination disorder. MDPI Sports 2024.\u003c/li\u003e\n\u003cli\u003eTeshome MS, Rameckers E, Mingels S, Granitzer M, Abessa TG, Bruckers L, et al. Effects of High-Intensity Motor Learning and Dietary Supplementation on Motor Skill-Related Physical Fitness in Thin Ethiopian Children Aged 5 to 7 Years: An Exploratory Pilot Cluster-Randomized Trial. Nutrients. 2024;17.\u003c/li\u003e\n\u003cli\u003eVerbecque E, Klingels K, Rameckers E, Ferguson G, Smits-Engelsman B. The construct of balance control in primary school-aged children: Unidimensional and task-specific. Hum Mov Sci. 2021;79:102847.\u003c/li\u003e\n\u003cli\u003eSmits-Engelsman B, Jelsma D, Coetzee D. Do We Drop the Ball When We Measure Ball Skills Using Standardized Motor Performance Tests? Children (Basel). 2022;9.\u003c/li\u003e\n\u003cli\u003eFarhat F, Ammar A, Mezghani N, Kammoun MM, Trabelsi K, Jahrami H, et al. Spatial Accuracy and Variability in Dart Throwing in Children with Developmental Coordination Disorder and the Relationship with Ball Skill Items. Eur J Investig Health Psychol Educ. 2024;14:1028-43.\u003c/li\u003e\n\u003cli\u003eFarhat F, Denysschen M, Mezghani N, Kammoun MM, Gharbi A, Rebai H, et al. Activities of daily living, self-efficacy and motor skill related fitness and the interrelation in children with moderate and severe Developmental Coordination Disorder. PLoS One. 2024;19:e0299646.\u003c/li\u003e\n\u003cli\u003eVerbecque E, Coetzee D, Ferguson G, Smits-Engelsman B. High BMI and Low Muscular Fitness Predict Low Motor Competence in School-Aged Children Living in Low-Resourced Areas. Int J Environ Res Public Health. 2021;18.\u003c/li\u003e\n\u003cli\u003eVerbecque E, Coetzee D, Smits-Engelsman B. Underweight children are agile but lack power. BMC Pediatr. 2022;22:490.\u003c/li\u003e\n\u003cli\u003eDoe-Asinyo RX, Smits-Engelsman BCM. Ecological validity of the PERF-FIT: correlates of active play, motor performance and motor skill-related physical fitness. Heliyon. 2021;7:e07901.\u003c/li\u003e\n\u003cli\u003eGravetter FJW, L.B. Statistics for the behavioral sciences (7th edition), international student edition. 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Gross motor skills trajectory variation between WEIRD and LMIC countries: A cross-cultural study. PLoS One. 2022;17:e0267665.\u003c/li\u003e\n\u003cli\u003eBarnett LM, Lai SK, Veldman SLC, Hardy LL, Cliff DP, Morgan PJ, et al. Correlates of Gross Motor Competence in Children and Adolescents: A Systematic Review and Meta-Analysis. Sports Med. 2016;46:1663-88.\u003c/li\u003e\n\u003cli\u003eMokkink LB, de Vet HCW, Prinsen CAC, Patrick DL, Alonso J, Bouter LM, et al. COSMIN Risk of Bias checklist for systematic reviews of Patient-Reported Outcome Measures. Qual Life Res. 2018;27:1171-9.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6033383/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6033383/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAfrica is facing an increasing prevalence of non-communicable diseases (NCDs) due to changing lifestyles and dietary habits. Children with developmental delays in motor coordination are particularly less inclined to engage in physical play and sports, putting them at risk of reduced fitness, overweight, and eventually NCDs. While several motor performance tests exist, they were not designed for African children and lack valid norms. As the results of an African-led initiative, a contextually relevant motor performance test was developed, the PERFormance and FITness test battery (PERF-FIT), that is open-source and specifically tailored for low-resource African settings. This study provides the first age- and sex-specific motor skill norms for African children aged 6\u0026ndash;12. By generating normative data alongside its previously established robust psychometric properties, the PERF-FIT is positioned as a critical resource for clinicians, educators, and policymakers working to monitor and enhance motor performance and physical fitness among African children.\u003c/p\u003e","manuscriptTitle":"Motor skills and fitness in African children: the PERF-FIT study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-28 07:02:04","doi":"10.21203/rs.3.rs-6033383/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c19836c3-fefc-4874-a165-00af50de94cb","owner":[],"postedDate":"February 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":44959709,"name":"Health sciences/Health care/Paediatrics/Paediatric research"},{"id":44959710,"name":"Health sciences/Health occupations"}],"tags":[],"updatedAt":"2025-04-08T13:37:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-28 07:02:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6033383","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6033383","identity":"rs-6033383","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}