Trial Outcomes & Findings for A PATH (Promoting Activity and Trajectories of Health) for Children (NCT NCT03189862)

A PATH (Promoting Activity and Trajectories of Health) for Children

Motor competence process measures will be scored using the Test of Gross Motor Development-3rd Edition; scores for the two subscales - locomotor (score range: 0-46) \& object-control (score range: 0-54) will be reported as raw scores for each skill \& an overall score total MC score which is created by summing the subscales( score range: 0 (low motor competence) - 100 (high motor competence)). Locomotor, object control, and total raw scores will be used for data analyses when appropriate. All scores are interpreted as a higher score indicating better outcomes.

ActiGraph GTX3+ tri-axial accelerometer will be used to measure the frequency, intensity and duration of PA among children at school and in free-living settings. Participants will be asked to wear the same accelerometer for 7 full days (5 week and 2 weekend days). Data will be collected at 80 hz. Cut points from a study in preschoolers by Butte et al will be applied to activity counts. This study utilized information from all three axes (versus just the vertical axis) thus time spent in sedentary, light, moderate, and vigorous categories will be defined as vector magnitudes of up to 819 (sedentary), 3907 (light), 6111 (moderate) and above 6112 for vigorous activity. The outcome will be minutes of moderate-to-vigorous PA per day, greater than 6111 activity counts.

Motor competence product measures will consist of 1) kick \& throw velocity, catching %; hop \& jump distance \& running speed. Product scores will vary for each participant (i.e., kick and throw velocity - faster score is an indicator of MC, number of successful catches out of 5 attempts - more catches indicator of MC, hop and jump distance and running speed; greater distance \& speed is a better indicator of MC. Catching % will not be calculated into the motor competence score due to updates in the literature regarding this specific outcome. All scores are standardized (z-scores, m=0, SD=1) and summed to get a composite for ball skills (z-kick velocity + z-throw velocity), locomotor skills (z-run speed + z-hop speed, + z-jump distance), and total (all summed). A higher score reflects better competence.

Motor competence process measures will be scored using the Test of Gross Motor Development-3rd Edition; scores for the two subscales - locomotor (score range: 0-46) \& object-control (score range: 0-54) will be reported as raw scores for each skill \& an overall score total MC score which is created by summing the subscales( score range: 0 (low motor competence) - 100 (high motor competence)). Locomotor, object control, and total raw scores will be used for data analyses when appropriate. All scores are interpreted as a higher score indicating better outcomes. Due to the covid-19 pandemic, data was only collected at the follow-up period in Year 2 (year 3 and 4 was not collected)

ActiGraph GTX3+ tri-axial accelerometer will be used to measure the frequency, intensity and duration of PA among children at school and in free-living settings. Participants will be asked to wear the same accelerometer for 7 full days (5 week and 2 weekend days). Data will be collected at 80 hz. Cut points from a study in preschoolers by Butte et al will be applied to activity counts. This study utilized information from all three axes (versus just the vertical axis) thus time spent in sedentary, light, moderate, and vigorous categories will be defined as vector magnitudes of up to 819 (sedentary), 3907 (light), 6111 (moderate) and above 6112 for vigorous activity. The outcome will be minutes of moderate-to-vigorous PA per day, greater than 6111 activity counts. More minutes of MVPA is better. Due to the covid-19 pandemic, data was only collected at the follow-up period in Year 2 (year 3 and 4 was not collected)

Will be assessed with the Harter \& Pike Pictorial Scale of PMC and Social Acceptance (PSPCSA). The PSPCSA will measure the child's global perceived physical competence. The PSPCSA physical competence subscale consists of six items that are presented in pictures and each child will select a picture that is more like them. The six items included are swinging, climbing, tying shoe laces, skipping, running, \& hopping.Children will (1) select the picture that is most like them. One picture depicts a child who is skilled competent and the other shows a child who is not skilled; (2) focus on the designated picture and indicate whether they are just a "little bit" or "a lot" like that picture. Separate pictures for girls and boys will be used in accordance with the manual procedures. The range of scores for each item on the test is 1 (low competence) to 4 (high competence), and children's final score is an average scaled score across all 6 items (1= low- 4=high).

Global perceived motor competence will be assessed with the Digital Scale of Perceived Motor Competence (DSPMC). THis video-based assessment allows children to see motor skills in action rather than a static picture. The scale is the identical layout and item structure to the PSPCSA but aligns with the 12 fundamental motor skills of the TGMD. For the assessment, the child will watch 12 sets of video pairs and select the video from each pair where the person moves most like them. One video depicts a child who is skilled and the other shows a child who is not skilled. Once children select the video where the person moved like them, they indicate whether the person in the video moved a "little bit" or "a lot" like themselves. The DSPMC yields three scores- locomotor (6 video pairs), ball skills (6 video pairs), and total (all 12 video pairs). The final score from each is an average scale score that ranges in value from 1 (low perceived competence) to 4 (high perceived competence).

Will be assessed with the Harter \& Pike Pictorial Scale of PMC and Social Acceptance (PSPCSA). The PSPCSA will measure the child's global perceived physical competence. The PSPCSA physical competence subscale consists of six items that are presented in pictures and each child will select a picture that is more like them. The six items included are swinging, climbing, tying shoe laces, skipping, running, \& hopping.Children will (1) select the picture that is most like them. One picture depicts a child who is skilled competent and the other shows a child who is not skilled; (2) focus on the designated picture and indicate whether they are just a "little bit" or "a lot" like that picture. Separate pictures for girls and boys will be used in accordance with the manual procedures. The range of scores for each item on the test is 1 (low competence) to 4 (high competence), and children's final score is an average scaled score across all 6 items (1= low- 4=high).

Global perceived motor competence will be assessed with the Digital Scale of Perceived Motor Competence (DSPMC). THis video-based assessment allows children to see motor skills in action rather than a static picture. The scale is the identical layout and item structure to the PSPCSA but aligns with the 12 fundamental motor skills of the TGMD. For the assessment, the child will watch 12 sets of video pairs and select the video from each pair where the person moves most like them. One video depicts a child who is skilled and the other shows a child who is not skilled. Once children select the video where the person moved like them, they indicate whether the person in the video moved a "little bit" or "a lot" like themselves. The DSPMC yields three scores- locomotor (6 video pairs), ball skills (6 video pairs), and total (all 12 video pairs). The final score from each is an average scale score that ranges in value from 1 (low perceived competence) to 4 (high perceived competence).

The Dimensional Change Cart Sort (DCCS) Task is a measure of cognitive flexibility. The task requires children to learn and remember a rule and apply it one way, and then apply a new rule as instructions change. Children match pictures that vary by two dimensions, shape (rabbit vs. boat) and color (brown vs. white). Children complete trials with one set of instructions, then another, and are encouraged to go as fast as they can without making mistakes. The final score was between 0-12, one point for each stimulus sorted correctly after the sort.

Working Memory will be assessed using a visual-spatial working memory task which requires children to accurately recall information they have seen before. Children are shown visual information (stickers on the body of a cartoon character) and next shown the character without the stickers, and asked to identify these locations after a brief retention interval. Test trials increase in difficulty (i.e., WM demand) as the task progresses. Test continues until a max. of 8 levels or failure on all 3 trials at the same level of difficulty. For working memory, more accurate responses reflect better self-regulation.WM capacity was indexed by a point score calculated as follows: beginning from Level 1, one point for each consecutive level in which at least two of the three trials were performed accurately, plus 1/3 of a point for all correct trials thereafter. Therefore, final scores are between 0-8 with higher scores reflecting better working memory.

The Head-Toes-Knees-Shoulders Task (HTKS; 10 min.) will be used to measure behavioral inhibition. It reflects a child's ability to remember commands and to behaviorally inhibit a pre-potent response in favor of a less-dominant response. A child is trained to perform actions in response to an examiner's commands (e.g., "touch your toes") then asked to do the opposite (e.g., touch toes when instruction is "touch your head"). Scores across trials are summed to reflect self-regulation. The task has begins with 6 practice items and between the first and second set of items there are 5 more practice trials. The score range is 0-60; higher score equal better behavioral inhibition.

Observed self-regulation will also evaluate the child ability to stay on-task during Head-Toes-Knees-Shoulders (HTKS) as an aspect of self-regulation. Child compliance and engagement will also be rated using the Child Assessor Report which has been used in prior SR trials. This 10-item questionnaire is scored on a 0-3 scale. The average scale score is taken across the 10-items, and higher score indicates better observed self-regulation behaviors.

Teacher-Reported. Teachers will report on child emotion regulation, another key aspect of SR at this age, using the 24-item Emotion Regulation Checklist (ERC), which generates Emotion Regulation and Negative Lability subscales. It is a 24 item, four-point Likert scale 1 = Never to 4 = Almost Always). The avg scale score is taken for both Emotional Regulation and Negative Labiltiy and a higher score indicates better emotional regulation (i.e., self-regulation behaviors).

Motor competence product measures will consist of 1) kick \& throw velocity, catching %; hop \& jump distance \& running speed. Product scores will vary for each participant (i.e., kick and throw velocity - faster score is an indicator of MC, number of successful catches out of 5 attempts - more catches indicator of MC, hop and jump distance and running speed; greater distance \& speed is a better indicator of MC. Catching % will not be calculated into the motor competence score due to updates in the literature regarding this specific outcome. All scores are standardized (z-scores, m=0, SD=1) and summed to get a composite for ball skills (z-kick velocity + z-throw velocity), locomotor skills (z-run speed + z-hop speed, + z-jump distance), and total (all summed). A higher score reflects better competence.

Body mass index (BMI) is a weight outcome that will be collected to calibrate actigraphs and as a confounding variable. Height and weight will be used to calculate BMI. Height will be measured to the nearest unit (in centimeters) in bare feet with the child standing upright against a portable stadiometer (Charder HM200P PortStad, Taiwan ROC). Weight will be measured to the nearest unit (in kilograms) with heavy clothes removed (ie, wearing pants and shirt) using a portable electric weight scale (Seca 813; Seca North America). Body mass index (BMI) will be calculated based on age-specific and sex-specific CDC (Centers for Disease Control and Prevention) growth charts using the following formula \~ weight (kg) / \[height (m)\]2. BMI scores are not linear and both very high and very low BMI scores are indicative of poor health. Due to the covid-19 pandemic, data was only collected at the follow-up period in Year 2 (year 3 and 4 was not collected)

Waist circumference is a weight outcome that will be collected as a confounding variable. The measure will be collected with the standard procedures - a non-elastic tape measure (Seca 201; Seca North America, Chino, California, USA) at the umbilicus. The measurement will be taken as the children complete a breath (ie, exhaled) to the nearest unit (in centimeters). Due to the covid-19 pandemic, data was only collected at the follow-up period in Year 2 (year 3 and 4 was not collected)

Body fat percentage is a weight outcome that will be collected as a confounding variable. A Tanita SC-331S foot-to-foot body composition analyzer (Tanita Cooperation, Tokyo, Japan) will be used to assess bioelectrical impedance. Measurements were collected using the standard setting after manually imputing the measured height, gender, and age of the subject. The children were bare foot and wore minimal clothing and were instructed to standstill with their feet touching all four metal plates. BF% was then estimated using the in-built Tanita equations. FM (kg) was calculated as: BF% divided by 100 and then multiplied by body weight and FFM (kg) was subsequently calculated as the difference of body weight and FM. Due to the covid-19 pandemic, data was only collected at the follow-up period in Year 2 (year 3 and 4 was not collected)