Adapted taekwondo training for skeletal development and motor proficiency in prepubertal children with developmental coordination disorder: a randomised controlled trial

Abstract

BackgroundDevelopmental coordination disorder (DCD) is a chronic neurodevelopmental movement disorder that affects 5–8% of primary school-aged children in Hong Kong Special Administrative Region, China. These children have a delay in skeletal development associated with reduced activity level. Taekwondo training has been acknowledged to improve bone health in young individuals. We aimed to assess the effectiveness of a novel, adapted taekwondo training regime on skeletal development and motor proficiency in children with DCD. MethodsIn this single-blinded, randomised controlled trial, prepubertal children with DCD were recruited from schools and non-governmental organisations in Hong Kong. They were randomly allocated to either taekwondo or control groups using computer-generated random codes. Children in the taekwondo group participated in a weekly 1 h adapted taekwondo training programme and daily taekwondo home exercises for 12 weeks. The control group participated in a daily jogging intervention. Data were collected at baseline, post-test, and 3 months after the intervention was initiated (follow-up test). The primary outcome was the ultrasonic bone age, and the secondary outcomes were the Movement Assessment Battery for Children (MABC) total motor impairment score and balance impairment subscore. Data analysis was based on intention to treat. The trial was registered with ClinicalTrials.gov (NCT02635711). Ethics approval was obtained from the Human Research Ethics Committee of the University of Hong Kong. Written informed consent was obtained from both children and parents. Findings145 children with DCD were recruited and randomly assigned to the taekwondo group (n=51; mean age 7·4 years, SD 1·2 years; 45 boys and 6 girls) and the control groups (n=94; mean age 7·5 years, SD 1·2 years; 76 boys and 18 girls). The demographics were well balanced between the two groups, but children in the control group had an older mean ultrasonic bone age at baseline (treated as a covariate). Two-way repeated measures analysis of covariance results revealed that ultrasonic bone age increased similarly (F1.6,220.6=5·806, 95% CI 7·34–7·61; p=0·006; ηp2 =0·04), and MABC total motor impairment score decreased similarly (F2,286=25·430, 95% CI 16·61–19·42; p<0·0001; ηp2 = 0·15) from baseline to follow-up in both groups. The MABC balance impairment subscore fell differentially by 0·95 points (22·1%) in the taekwondo group from baseline to follow-up test (p=0·019; 95% CI 0·16–1·74). No adverse events were reported. InterpretationThe 3 month adapted taekwondo programme improved functional balance performance in children with DCD. However, with respect to skeletal development and general motor proficiency, the effect of maturation might be more profound than that of taekwondo. Further studies could increase the taekwondo training duration and use bone growth as a biomarker instead of ultrasonic bone age. FundingHealth and Medical Research Fund (13142081), Food and Health Bureau of Hong Kong Government.