key: cord-0997999-h8v0a318 authors: Lima, Rodrigo A.; Drenowatz, Clemens; Pfeiffer, Karin A. title: Expansion of Stodden et al.’s Model date: 2022-02-07 journal: Sports Med DOI: 10.1007/s40279-021-01632-5 sha: 7cf66803931e6fb6004167b41ebbc3dd976e4023 doc_id: 997999 cord_uid: h8v0a318 nan In 2008, Stodden et al. [1] published a framework model hypothesising the relationships among motor competence, physical activity, perceived motor competence, healthrelated fitness and weight status in children and adolescents. As a result, many subsequent investigations tested elements of the concepts depicted in the Stodden et al. [1] framework. Stodden [2] . From the 36 pathways evaluated, there were 18 pathways (50%) without a sufficient number of studies (minimum of four studies) to draw conclusions, and five pathways presented indeterminate/inconsistent evidence. From the 13 remaining pathways, nine (22% from 36 pathways) exhibited strong evidence. The other four pathways were not supported by the literature [2] . A complete synthesis is provided in Fig. 1 , which is taken from Barnett et al.'s review [2] and allows for drawing the following conclusions: activity are the most critical pathways to interpret. The direct pathways between motor competence and physical activity showed no or indeterminate evidence to support their relationship, except the pathway from composite motor competence to physical activity, which showed strong and positive evidence of the relationship. On the other hand, the reciprocal pathway between motor competence and physical activity mediated via health-related fitness exhibited strong evidence supporting it. In addition to better assessment of physical activity and motor competence, it might be necessary to account for age group differences in this relationship as an increase in the strength of the relationship between motor competence and physical activity is expected with increasing age [1] . The importance of age in the motor competence-physical activity relationship needs to be better addressed. 3. The relationship from overall motor competence to health-related fitness was strong and positive whereas the reverse pathway was indeterminate. Considering only locomotor motor competence, rather than total motor competence, there was, however, strong evidence supporting the reciprocal pathway with health-related fitness. Nevertheless, there was an insufficient number of studies evaluating object control and composite constructs of motor competence in relation to health-related fitness. 4. The pathway between motor competence and weight status showed strong evidence supporting the relation-ship in both directions despite the insufficient number of studies evaluating most of the pathways. Despite the need for further evaluation, the publication of Stodden [1] . The dotted arrows between blocks of variables represent the expected relationship between all or at least most variables in the previous block with the following block of variables. As an illustration, besides the relationships between blocks A and B foreseen by Stodden et al. [1] , we expect physical activity, health-related fitness, motor competence and weight status (variables in Block B) to be directly associated with the variables in the Block C (delimited by the dotted orange square). The predicted placement and relationship among variables in this proposed model (Fig. 2) are detailed below. "0" Mediated via Strength of evidence calculated on proportion of significant investigations in the hypothesized direction divided by the total investigations. Based on the percentage of findings supporting the association, the variable was classified as either no association (0-33 %), written as "0"; indeterminate/inconsistent (34-59 %), written as "?"; or a positive "+" or negative "−" association (≥60 %). When four or more studies found an association, it was classified as "++" or "− −" accordingly. If there were three or less studies in the skill domain, the strength of evidence was not classified. Studies with >4 analyses comparisons within the one study were excluded in the final calculation of evidence so as not to skew results. "++" Mediated via From the group of outcomes first included in the Stodden et al. model, especially physical activity, health-related fitness and weight status have been linked to metabolic health (triglycerides, glucose, insulin, cholesterol, blood pressure, etc.) in children and adolescents [6] [7] [8] . Metabolic health might mediate the impact of increased physical activity, health-related fitness and motor competence in relation to weight status [9] . Moreover, metabolic health might also be a result of improved weight status because of changes in physical activity, health-related fitness and motor competence levels [10] . The 'placement' of metabolic health in the Stodden et al. model might be related to the age-group in focus. In younger children, it is expected that metabolic health is impacted by weight status, whereas metabolic health and weight status might present a more symbiotic relationship with increasing age. A considerable number of studies have linked physical activity and health-related fitness to cognition and academic performance [11] [12] [13] . More recently, motor competence has been shown to be associated with cognition and academic performance [14] . Although understudied, physical activity, health-related fitness and motor competence are hypothesised to be related to cognition and academic performance via neurobiological, psychosocial and behavioural mechanisms [15, 16] . We presume that physical activity, healthrelated fitness and motor competence may be associated with cognition and academic performance both directly and mediated via weight status. Motor competence, physical activity, health-related fitness and weight status have been associated with mental health in children and adolescents [15, [17] [18] [19] [20] [21] . It is feared that the mental health of youth might deteriorate as a consequence of the Covid-19 pandemic. Therefore, it is of the highest priority to conduct original studies investigating the role of the Stodden et al. model in relation to child and adolescent mental health. The causal mechanisms linking the variables in the Stodden et al. [1] model with mental health are still unclear, but the few studies there are, indicate the importance of neurobiological, psychosocial and behavioural mechanisms [15, 22] . There is evidence supporting the inclusion of mental health after weight status in the Stodden et al. model [15, [17] [18] [19] [20] [21] , although mental health has also been shown to be mutually related to weight status, especially during adolescence [23] . We urge the scientific community to evaluate the Stodden et al. [1] model in depth. Longitudinal work, especially experimental research using different doses of interventions, is needed. Priority should be given to studies with longerterm follow-ups and multiple monitoring periods since the progression of the associations between pathways across time is still under-evaluated. The developmental nature of the relationships is a critical element in the Stodden et al. model that needs further analysis. 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