Gross Motor Skills and Cardiometabolic Risk in Children: A Mediation Analysis

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The purpose of this study was to examine the linear relationship between gross motor skills and cardiometabolic risk, with aerobic fitness as a mediator variable, in low-income children from the United States.


Participants were a convenience sample of 224 children (mean ± SD age = 9.1 ± 1.1 yr; 129 girls and 95 boys) recruited from five low-income elementary schools from the Mountain West Region of the United States. Gross motor skills were assessed using the Test for Gross Motor Development, 3rd Edition. Gross motor skills were analyzed using a locomotor skill, a ball skill, and a total gross motor skill score. Aerobic fitness was assessed using the Progressive Aerobic Cardiovascular Endurance Run that was administered during physical education class. A continuous and age- and sex-adjusted metabolic syndrome score (MetS) was calculated from health and blood marker measurements collected in a fasted state before school hours. Total effects, average direct effects, and indirect effects (average causal mediation effect) were calculated using a bootstrap mediation analysis method via a linear regression algorithm.


The average causal mediation effect of gross locomotor skills on MetS scores, using aerobic fitness as the mediator variable, was statistically significant (β = −0.055, 95% confidence interval = −0.097 to −0.021, P = 0.003). The model explained approximately 17.5% of the total variance in MetS with approximately 43.7% of the relationship between locomotor skills and MetS mediated through aerobic fitness. Ball skills did not significantly relate with cardiometabolic risk.


There is a significant relationship between gross locomotor skills and cardiometabolic risk that is partially mediated through aerobic fitness in a sample of low-income children from the United States.

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