Movement in children is critical to physical, mental, and emotional adjustment in childhood and adolescence . Key child health issues of international importance include childhood obesity, and its serious health implications, and mental health issues such as anxiety and depression.
The world prevalence of overweight in school-aged children has been estimated at 10% with 25% of these being obese . Furthermore, this proportion continues to rise, particularly in economically developed regions such as Canada and Australia. However, interventions targeting diet and/or physical activity have had limited success . Furthermore, childhood overweight/obesity is not just associated with poor physical health but also poor psychosocial health, particularly in boys .
Anxiety and depression are the most common mental health problems experienced by Australian children and adolescents , and are significant problems worldwide . Depressive disorders have been estimated to have a lifetime prevalence in adolescence of between 15 - 20% and 6 month prevalence in adolescence of between 5 - 6% and between 1 - 3% in children [7, 8]. The 12 month prevalence rates for anxiety disorders are approximately 8% in children and between 11% and 20% in adolescents . Internalising problems such as anxiety and depression are particularly burdensome for children, interfering with social, cognitive, emotional, and academic life at a time when other children are building skills and competencies [10, 11].
Motor ability is linked with obesity and mental health
In addressing these two key childhood issues of obesity and poor mental health, an approach that has been overlooked is one which links these problems in early development, namely their relationship with motor ability.
It is well established that a lack of physical activity is considered a key factor underlying childhood obesity , and a lack of physical activity has been linked to other problems such as lower mineral density and cardiovascular risk factors . Children with poor motor ability have been found to engage less in physical activities than other children . To engage successfully in physical activities children need to have a certain degree of motor competence, and competence motivation theorists such as Harter  argue that confidence in his or her own ability to perform any activity partly determines the child's involvement level. If children are confident with their motor skills, they are more likely to engage in physical activities such as sports, dancing and other physical activity programs outside of the school curriculum . Trost et al.  found that in sixth grade children, physical activity self-efficacy was a key variable which distinguished the obese and non-obese children. Previous research [1, 17]has demonstrated that children with poor motor ability perceive themselves as less athletically competent, which has been linked to higher levels of anxiety  and depressive symptomatology .
Schoemaker and Kalverboer  established a link between motor coordination difficulties and social and affective problems in children as young as 6 years. Since then, research has identified that children with motor deficits have social and emotional problems such as poorer self-worth [1, 20], and have higher levels of anxiety [1, 21], and depression [18, 22]. Piek, Bradbury et al.'s study  found that kindergarten children's level of motor coordination was negatively related to anxious/depressed behavior as reported by the mother, which is consistent with the finding for older children. However, this finding is of serious concern as these children were only 4-5 years of age. Furthermore, recent findings have shown that gross motor performance in infancy and early childhood predict later anxiety and depressive symptomatology in school age children , and if young school-age children have both motor and anxiety problems they are more likely to have psychosocial difficulties in adolescence .
Motor ability is linked with other aspects of development
Until recently, there has been little evidence provided for a relationship between motor ability and other aspects of development such as cognitive and language development. However, recently, an association between early development of gross motor skills and later cognitive abilities in children  and adults  has been identified. Other research  has found that motor ability in children is related to cognitive, language and empathic ability. Children with poor motor ability have been found to perform more poorly on cognitive tasks such as working memory [25, 28], and emotional recognition . Poor motor ability is also associated with many of the major developmental disorders such as Attention Deficit Hyperactivity Disorder [30, 31], language impairment , Reading Disability  and Autism . Many of these disorders have been found to be comorbid with Developmental Coordination Disorder (DCD), recognised by the American Psychiatric Association through its inclusion in the DSM-III in 1987 and in subsequent editions . Children with DCD have a significant impairment in their motor coordination that cannot be attributed to any neurological deficit.
A recent study by Bart, Hajami and Var-Haim  identified the importance of motor ability in kindergarten on the transition to school. They found that motor function at the kindergarten (equivalent to our Pre-Primary) stage was predictive of scholastic adaptation and social and emotional adjustment 12 months later in the child's first year of school. This finding is particularly relevant to the proposed project.
Interventions to improve motor ability
Despite the importance of motor development, there has been surprisingly little research examining the most effective way of teaching motor skills in schools. A primary focus has been on physical activity and sport skills, but there has been less emphasis on appropriate skill development for everyday functioning, particularly fine motor ability that is crucial for skills such as hand-writing. There are many motor skills programs currently available, but there is little information on how effective they are, and few have been developed for the Pre-Primary age. The Move it Groove it program, based in the state of New South Wales in Australia, was developed for 8 to 10 year olds . Based on the mastery of fundamental movement skills (FMS), the developers of this program argued that it produced substantial improvement in movement skills over a relatively short period of time. Another program that relies on the development of FMS is the FMS program  that has been adopted by the Department of Education in Western Australia. There are three categories of skills that are included, body management (4 skills); locomotor skills (9 skills) and object control (9 skills - all ball skills). The argument behind this approach is that fundamental skills such as running, throwing, skipping and balancing are the building blocks for improving more complex sports. As mentioned before, the focus is on sports and physical activity participation. The latter program has not had any published reviews of its efficacy. The Sports Play and Recreation for Kids program  was developed in the US for elementary students and has been evaluated. This program included classes taught by movement experts as well as others by trained teachers. Both were found to increase physical activity levels in class. They also demonstrated improved movement skills. However, in all of these programs there is a lack of emphasis on fine motor ability, and it is known that both fine and gross motor ability are important for appropriate skill and mental health development . In particular, poor motor ability has been linked to poor visual-spatial organisation [41, 42], and this component needs to be more seriously considered in early movement programs.
According to Trost et al. [43
], the following are important to include in physical activity intervention programs for children:
provide activities that are developmentally appropriate so children can succeed
provide the opportunity to observe influential others such as parents and peers performing physical activity
provide verbal encouragement to participate
reduce or eliminate grading or competition in the activity in order to reduce anxiety.
Another important factor is to ensure that the program is inclusive, that is, adopting a universal program for all children within the class. By including all children it reduces the stigma associated with being placed into a 'special' program. Furthermore, given that socially disadvantaged children are generally at higher risk for physical and mental health problems , universal interventions with socially disadvantaged children are likely to help prevent a higher proportion of problems in these children. For sustainability and continuity to be maximised it has also been argued that community interventions based in the school or home environment are the most appropriate places for universal interventions to occur . Including all children is a challenge, as it means it must be interesting and exciting for those students who are both physically and socially competent, while being easy enough for the students who are struggling.
In order to accommodate both these needs, the program needs to provide considerable flexibility. These were the key concerns when developing the Animal Fun program.
The Animal Fun program
The Animal Fun program is a Pre-Primary program developed to promote motor and social development. It includes four modules focusing on gross motor development, four modules focusing on fine motor development, and a module on social/emotional development.
The gross motor modules are designed to promote good static and dynamic balance, increase strength in lower limb muscles, and to develop an interest in locomotor activities such as running, skipping, jumping, climbing and hopping, correct techniques for throwing, catching and kicking, and more complex movement based on combining movements together.
The fine motor modules include activities that develop postural stability, and strengthen shoulder, elbow, wrist and hand muscles. They are also designed to develop sequencing in fine motor activities, and promote pre-scissor and pre-writing skills. The more advanced skills involve tool manipulation and the development of successful, mature and functional use of pencils, scissors, keyboards, mouse and joystick.
The social/emotional module includes activities where children are taught to accurately identify, label and monitor their feelings . It is based on the Aussie Optimism program (AOP) developed by Clare Roberts  and adapted for younger children by Rosie Rooney .The Aussie Optimism Feelings and Friends Program is a 10-module program that has been adapted for year 1 and 2 students as well as a version for slightly older students in year 3 whose reading and writing skills and emotional repertoire is more developed. The programs include cognitive and behavioural intervention strategies and targets social, emotional and cognitive risk and protective factors for anxiety and depression. In modifying this for Pre-Primary children, the Animal Fun program has focused on the modules of Laughter, Identifying and labeling feelings, Breathing, and Relaxation.
The movement components of the Animal Fun program were developed based on the principle that to be successful in movement activities, children need to have a degree of motor competence, plus confidence in their ability to perform the activity . Appropriate technique is an important aspect of motor skill development. However, research demonstrates that if children enjoy movement activities then it is more likely that they will participate, and will begin to build skills . Participation promotes social interaction but also leads to practice which is the key to improving skills. In other words, if the children enjoy what they are doing, they will practice it and will improve their skills. Another key principle is how meaningful it is to the child . By imitating animals as part of the program, the child can attach meaning to the tasks which adds to the fun and enjoyment.
The Animal Fun program was developed in consultation with teachers, developmental and clinical psychologists, physiotherapists, occupational therapists, speech therapists and health professionals working in the field with children who have motor disorders. The process involved an 8 month initial development followed by a pilot study and subsequent program refinement.
The pilot study was conducted with 120 children from 3 schools in low socioeconomic areas, with one school having the intervention and the other two smaller schools as controls. Pre-testing occurred in school term 1, the Animal Fun program was delivered in school terms 2 and 3, and post-testing occurred in term 4. Both motor and psychosocial variables were recorded pre- and post- intervention. Given the short time-frame, improvement in motor development was not anticipated (and not found) at post-testing, although it was anticipated that it would be observed later in development, hence the need to follow the children's progress into Year 1.
However, there were very promising psychosocial findings. Teachers returned 87 Social Skills Rating Scales (teacher version) forms, and a MANCOVA including all three subtests (cooperation, self-control and assertion) gave a statistically significant time x group interaction (F(3, 81) = 10.363, p <.001; partial η2 =.277). Univariate analyses showed that the intervention produced a significant improvement in cooperation (F(1,83) = 21.507, p <.001; partial η2 =.206). Behavioural measures of internalising, externalising, problem behaviour and academic competence failed to reach significance but all showed improvements in the predicted direction for the intervention group. At the conclusion of the post-testing, a focus group was run to determine the teachers' views on the program. All teachers found it easy to incorporate into the curriculum, and all were positive about the program with some of the comments as follows: The program was "really fun -the kids love it"; "easy to use and easy to follow"; "flexible", "was very adaptable"; "very little preparation time"; "good range of difficulty levels"; "all children joined in" With pilot study results showing an improvement in social skills and greater power being needed to evaluate the other potentially beneficial effects of the program, a large randomised controlled trial evaluating the efficacy of Animal Fun is needed.
In addition to the importance of motor ability for physical activity and fine motor skills such as hand-writing, movement skills are also linked with social interaction and social-emotional adjustment. There is also evidence that the early years before formal school may be an important time to invest in motor development given its relationship with the transition to school . Given the promising results provided by our pilot study for the Animal Fun program, the current study proposes to evaluate the program in a randomised control trial with a larger sample of Pre-Primary children in both metropolitan and regional schools, to determine the impact on motor and psychosocial development immediately after the intervention and then 12 months following intervention once the child has entered grade 1 of school.