Objectives Preschoolers 3-5 years of age are in a crucial stage of motor skill competence. While preschoolers develop their motor skill competence through engagement in physical activity, a majority of them fail to meet guideline-recommended physical activity level. This study reviews scientific evidence on the relationship between motor skill competence and physical activity among preschoolers. Methods This systematic review followed the PRISMA framework. Keyword and reference search were conducted in PubMed, Cochrane Library, PsycINFO, Web of Science, and Google Scholar. Inclusion criteria included-age: 3-5 years of age; setting: preschool environment (e.g., preschool, childcare, head start); main outcomes: motor skill competence and physical activity; study design: cross-sectional study, case-control study, retrospective cohort study, prospective cohort study, or randomized controlled trial; language: English; and article type: peer-reviewed publication. Results Eleven studies met the inclusion criteria, including 6 randomized controlled trials and 5 cross-sectional studies. Studies were conducted in 5 countries: United States (5), United Kingdom (2), Australia (2), Switzerland (1), and Finland (1). Eight out of the 11 studies included in the review reported a significant relationship between motor skill competence and physical activity. The specific pattern and strength of the relationship tend to differ by gender, physical activity intensity, motor skill type, and day of the week (weekdays versus weekends). Conclusions An association has been consistently documented between motor skill competence and physical activity. Future research is warranted to elucidate the underlining causal link, examine potential heterogeneity, and determine the role of environment in the relationship between motor skill competence and physical activity among preschoolers.

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Authors' contributions: KKD is the principal investigator and is responsible for overall direction and conduct of the study; KKD conceived the study along with co-investigators JMJ, EMT and SH. JM leads the study's participatory process and developed the empowerment measures. SH, the study biostatistician, developed the analytic strategy and will oversee primary data analyses. EMT oversees the assessment of environmental factors affecting intervention outcomes. JB led preparation of this paper, co-developed the Parents Connect for Healthy Living (PConnect) curriculum, and participates in survey preparation, participant recruitment, and data collection. AAT manages the implementation of the study, participates in survey preparation, participant recruitment and data collection, and co-developed the Parents Connect for Healthy Living (PConnect) curriculum. NK oversaw the quality and integrity of the data. KL, CK, and AV oversee day-to-day implementation of the intervention within Head Start and assist with recruitment, data collection, and data processing. AG developed the online Community Resource Guide and participates in survey preparation, participant recruitment, and data collection. RF and BK assisted with the intervention design and participate in survey preparation, participant recruitment, and data collection. RK and RB participated in intervention design and RB designed all intervention artwork. All of the authors have reviewed, edited, and approved the manuscript.

Objectives: Consistent with empowerment theory, parental empowerment acts as a mechanism of change in family-based interventions to support child health. Yet, there are no comprehensive, validated measures of parental health-related empowerment to test this important perspective. Informed by empowerment theory and in the context of a community-based obesity intervention, we developed a self-report measure of parental health-related empowerment and tested its preliminary validity with low-income parents. Methods: The Parental Empowerment through Awareness, Relationships, and Resources (PEARR) is a 21-item scale designed to measure three subdimensions of empowerment including resource empowerment, critical awareness, and relational empowerment. In the fall of 2017 or the fall of 2018, low-income parents (n = 770, 88% mothers) from 16 Head Start programs in Greater Boston completed the PEARR. The resulting data were randomly split into two equal samples with complete data. The factorial structure of the PEARR was tested in the first half of the sample using principal component analysis (PCA) and exploratory factor analysis (EFA) and subsequently confirmed with the second half of the sample using confirmatory factor analysis (CFA). Internal consistency coefficients were calculated for the final subscales. Results: Results from the PCA and EFA analyses identified three component factors (eigenvalues = 8.25, 2.75, 2.12) with all items loading significantly onto the hypothesized subdimension (β > 0.59 and p < 0.01). The three-factor model was subsequently confirmed with the second half of the sample using CFA (β > 0.54 and p < 0.01). Fit indices met minimum criteria (Comparative Fit Index = 0.95, Root Mean Square Error of Approximation = 0.05 (0.05, 0.06), Standardized Root-Mean-Square Residual = 0.05). Subscales demonstrated strong internal consistency (α= 0.83–0.90). Conclusions: Results support initial validity of a brief survey measuring parental empowerment for child health among Head Start parents. The PEARR can be utilized to measure changes in parental empowerment through interventions targeting empowerment as a mechanism of change.