Skip to main content Accessibility help

Cross-sectional associations of physical activity and gross motor proficiency with adiposity in South African children of pre-school age

  • Catherine E Draper (a1) (a2), Simone A Tomaz (a1), Rachel A Jones (a3), Trina Hinkley (a4), Rhian Twine (a5), Kathleen Kahn (a5) (a6) (a7) and Shane A Norris (a2)...



The study aimed to investigate the relationship between physical activity, gross motor skills and adiposity in South African children of pre-school age.


Cross-sectional study.


High-income urban, and low-income urban and rural settings in South Africa.


Children (3–6 years old, n 268) were recruited from urban high-income (n 46), urban low-income (n 91) and rural low-income (n 122) settings. Height and weight were measured to calculate the main outcome variables: BMI and BMI-for-age Z-score (BAZ). Height-for-age and weight-for-age Z-scores were also calculated. Actigraph GT3X+ accelerometers were used to objectively measure physical activity; the Test of Gross Motor Development (Version 2) was used to assess gross motor skills.


More children were overweight/obese and had a higher BAZ from urban low-income settings compared with urban high-income settings and rural low-income settings. Being less physically active was associated with thinness, but not overweight/obesity. Time spent in physical activity at moderate and vigorous intensities was positively associated with BMI and BAZ. Gross motor proficiency was not associated with adiposity in this sample.


The findings of this research highlight the need for obesity prevention particularly in urban low-income settings, as well as the need to take into consideration the complexity of the relationship between adiposity, physical activity and gross motor skills in South African pre-school children.


Corresponding author

*Corresponding author: Email


Hide All

Address for correspondence: Sports Science Institute of South Africa, Boundary Road, Newlands, Cape Town 7700, South Africa.



Hide All
1. de Onis, M, Blossner, M & Borghi, E (2010) Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr 92, 12571264.
2. Black, RE, Victora, CG, Walker, SP et al. (2013) Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 382, 427451.
3. Ebbeling, CB, Pawlak, DB & Ludwig, DS (2002) Childhood obesity: public-health crisis, common sense cure. Lancet 360, 473482.
4. Lobstein, T, Baur, L, Uauy, R et al. (2004) Obesity in children and young people: a crisis in public health. Obes Rev 5, Suppl. 1, 4104.
5. Reilly, JJ, Methven, E, McDowell, ZC et al. (2003) Health consequences of obesity. Arch Dis Child 88, 748752.
6. Reilly, JJ (2008) Physical activity, sedentary behaviour and energy balance in the preschool child: opportunities for early obesity prevention. Proc Nutr Soc 67, 317325.
7. Shisana, O, Labadarios, D, Rehle, T et al. (2013) South African National Health and Nutrition Examination Survey (SANHANES-1). Cape Town: HSRC Press.
8. Gebremedhin, S (2015) Prevalence and differentials of overweight and obesity in preschool children in Sub-Saharan Africa. BMJ Open 5, e009005.
9. Lundeen, EA, Norris, SA, Adair, LS et al. (2016) Sex differences in obesity incidence: 20-year prospective cohort in South Africa. Pediatr Obes 11, 7580.
10. de Onis, M, Blössner, M & Borghi, E (2012) Prevalence and trends of stunting among pre-school children, 1990–2020. Public Health Nutr 15, 142148.
11. Akombi, BJ, Agho, KE, Merom, D et al. (2017) Child malnutrition in sub-Saharan Africa: a meta-analysis of demographic and health surveys (2006–2016). PLoS One 12, e0177338.
12. The World Bank (2018) Overview: South Africa. (accessed August 2018).
13. te Velde, SJ, van Nassau, F, Uijtdewilligen, L et al. (2012) Energy balance‐related behaviours associated with overweight and obesity in preschool children: a systematic review of prospective studies. Obes Rev 13, Suppl. 1, 5674.
14. Byun, W, Dowda, M & Pate, RR (2011) Correlates of objectively measured sedentary behavior in US preschool children. Pediatrics 128, 937945.
15. Martinez-Gomez, D, Eisenmann, JC, Tucker, J et al. (2011) Associations between moderate-to-vigorous physical activity and central body fat in 3–8-year-old children. Int J Pediatr Obes 6, e611e614.
16. Chaput, JP, Lambert, M, Mathieu, ME et al. (2012) Physical activity vs. sedentary time: independent associations with adiposity in children. Pediatr Obes 7, 251258.
17. Vale, SMCG, Santos, RMR, Soares-Miranda, LMDC et al. (2010) Objectively measured physical activity and body mass index in preschool children. Int J Pediatr 2010, 479439.
18. Morano, M, Colella, D & Caroli, M (2011) Gross motor skill performance in a sample of overweight and non-overweight preschool children. Int J Pediatr Obes 6, 4246.
19. Lubans, DR, Morgan, PJ, Cliff, DP et al. (2010) Fundamental movement skills in children and adolescents. Sports Med 40, 10191035.
20. Okely, AD, Booth, ML & Chey, T (2004) Relationships between body composition and fundamental movement skills among children and adolescents. Res Q Exerc Sport 75, 238247.
21. Truter, L, Pienaar, AE & Toit Du, D (2012) The relationship of overweight and obesity to the motor performance of children living in South Africa. S Afr Fam Pract J 54, 429435.
22. Barnett, LM, Lai, SK, Veldman, SLC et al. (2016) Correlates of gross motor competence in children and adolescents: a systematic review and meta-analysis. Sports Med 46, 16631688.
23. Draper, CE, Tomaz, SA, Stone, M et al. (2017) Developing intervention strategies to optimise body composition in early childhood in South Africa. Biomed Res Int 2017, 5283457.
24. Kimani-Murage, EW, Kahn, K, Pettifor, JM et al. (2010) The prevalence of stunting, overweight and obesity, and metabolic disease risk in rural South African children. BMC Public Health 10, 158.
25. Collinson, MA, Tollman, SM, Kahn, K et al. (2006) Highly prevalent circular migration: households, mobility and economic status in rural South Africa. In Africa on the Move: African Migration and Urbanisation in Comparative Perspective, pp. 194216 [M Tienda, SE Findley, S Tollman et al., editors]. Johannesburg: Wits University Press.
26. Kahn, K, Collinson, MA, Gómez-Olivé, FX et al. (2012) Profile: Agincourt health and socio-demographic surveillance system. Int J Epidemiol 41, 9881001.
27. Cole, TJ & Lobstein, T (2012) Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity. Pediatr Obes 7, 284294.
28. Hinkley, T, O’Connell, E, Okely, AD et al. (2012) Assessing volume of accelerometry data for reliability in preschool children. Med Sci Sports Exerc 44, 24362441.
29. Cliff, DP, Reilly, JJ & Okely, AD (2009) Methodological considerations in using accelerometers to assess habitual physical activity in children aged 0–5 years. J Sci Med Sport 12, 557567.
30. Janssen, X, Basterfield, L, Parkinson, KN et al. (2015) Objective measurement of sedentary behavior: impact of non-wear time rules on changes in sedentary time. BMC Public Health 15, 504.
31. Evenson, KR, Catellier, DJ, Gill, K et al. (2008) Calibration of two objective measures of physical activity for children. J Sports Sci 26, 15571565.
32. Janssen, X, Cliff, DP, Reilly, JJ et al. (2013) Predictive validity and classification accuracy of ActiGraph energy expenditure equations and cut-points in young children. PLoS One 8, e79124.
33. Ulrich, DA (2000) Test of Gross Motor Development – 2. Austin, TX: PRO-ED.
34. Cliff, DP, Okely, AD, Morgan, PJ et al. (2012) Proficiency deficiency: mastery of fundamental movement skills and skill components in overweight and obese children. Obesity (Silver Spring) 20, 10241033.
35. Barnhart, HX, Haber, M & Song, J (2002) Overall concordance correlation coefficient for evaluating agreement among multiple observers. Biometrics 58, 10201027.
36. Howard, SJ, Cook, CJ, Mohamed, RS et al. (2016) The (possibly negative) effects of physical activity on executive functions: implications of the changing metabolic costs of brain development. J Phys Act Health 13, 10171022.
37. Abrahams, Z, Mchiza, Z & Steyn, NP (2011) Diet and mortality rates in Sub-Saharan Africa: stages in the nutrition transition. BMC Public Health 11, 801.
38. Sedibe, MH, Feeley, AB, Voorend, C et al. (2014) Narratives of urban female adolescents in South Africa: dietary and physical activity practices in an obesogenic environment. S Afr J Clin Nutr 27, 114119.
39. Mayosi, BM, Flisher, AJ, Lalloo, UG et al. (2009) The burden of non-communicable diseases in South Africa. Lancet 374, 934947.
40. Steyn, NP, Nel, J, Labadarios, D et al. (2014) Which dietary diversity indicator is best to assess micronutrient adequacy in children 1 to 9 y? Nutrition 30, 5560.
41. Naicker, N, Mathee, A & Teare, J (2015) Food insecurity in households in informal settlements in urban South Africa. S Afr Med J 105, 268270.
42. Jones, S, Hendricks, S & Draper, CE (2014) Assessment of physical activity and sedentary behavior at preschools in Cape Town, South Africa. Child Obes 10, 501510.
43. Kuhl, ES, Clifford, LM & Stark, LJ (2012) Obesity in preschoolers: behavioral correlates and directions for treatment. Obesity (Silver Spring) 20, 329.
44. Prioreschi, A, Wrottesley, S, Draper, CE et al. (2017) Maternal and early life nutrition and physical activity: setting the research and intervention agenda for addressing the double burden of malnutrition in South African children. Glob Health Action 10, 1301085.


Type Description Title
Supplementary materials

Draper et al. supplementary material
Tables S1-S6

 Word (37 KB)
37 KB

Cross-sectional associations of physical activity and gross motor proficiency with adiposity in South African children of pre-school age

  • Catherine E Draper (a1) (a2), Simone A Tomaz (a1), Rachel A Jones (a3), Trina Hinkley (a4), Rhian Twine (a5), Kathleen Kahn (a5) (a6) (a7) and Shane A Norris (a2)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed