Balance-Cognitive-Strength Training for Balance, Inhibitory Control, and Gait in Preschool Children

The Single-Task Gait Index was derived from gait variables measured during normal walking. Gait was assessed using a gait analysis system during single-task walking. Variables included stance time, stride time, double-support time, step width variability, loading rate, and related temporal-spatial gait parameters. Variables were standardized and direction-unified before construction of the gait index. Higher scores indicate better single-task gait performance. The change score was calculated as the post-intervention score minus the baseline score.

The Dual-Task Gait Index was derived from gait variables measured while children walked and performed a concurrent cognitive task. During dual-task walking, participants walked while counting backward from 10 to 1. Variables included stance time, stride time, double-support time, step width variability, loading rate, and related temporal-spatial gait parameters. Variables were standardized and direction-unified before construction of the gait index. Higher scores indicate better gait performance under cognitive load. The change score was calculated as the post-intervention score minus the baseline score.

Balance ability was assessed using static and dynamic balance tasks on a Zebris force platform. The Balance Composite Score was constructed from standardized balance variables using principal component analysis. The composite score reflected anterior-posterior sway control, load symmetry, and dynamic postural adjustment. Negative indicators, such as center-of-pressure velocity and ellipse area, were direction-unified before score calculation. Higher scores indicate better overall balance ability. The change score was calculated as the post-intervention score minus the baseline score.

Inhibitory control was assessed using an iPad-based Go/No-Go task from the Early Years Toolbox. Children were instructed to respond to Go stimuli and inhibit responses to No-Go stimuli. Accuracy and reaction time were standardized and direction-unified to create an inhibitory control composite score. Higher scores indicate better inhibitory control. The change score was calculated as the post-intervention score minus the baseline score.

Motor development was assessed using the Movement Assessment Battery for Children, Second Edition (MABC-2), age band 1 for children aged 3 to 6 years. The total test standard score was derived from the manual dexterity, aiming and catching, and balance components. Higher standard scores indicate better motor development. The change score was calculated as the post-intervention score minus the baseline score.

Manual dexterity was assessed using the MABC-2 age band 1 manual dexterity tasks, including fine motor tasks such as posting coins, threading beads, and drawing trail. Scores were converted according to the MABC-2 scoring manual. Higher component scores indicate better manual dexterity. The change score was calculated as the post-intervention score minus the baseline score.

Aiming and catching ability was assessed using the MABC-2 age band 1 aiming and catching tasks, including catching and throwing tasks. Scores were converted according to the MABC-2 scoring manual. Higher component scores indicate better ball skill and object-control performance. The change score was calculated as the post-intervention score minus the baseline score.

Motor balance was assessed using the MABC-2 age band 1 balance tasks, including static and dynamic balance tasks such as one-leg balance, walking with heels raised, and jumping tasks. Scores were converted according to the MABC-2 scoring manual. Higher component scores indicate better balance-related motor development. The change score was calculated as the post-intervention score minus the baseline score.

Agility and movement speed were assessed using the 10-meter shuttle run from the Chinese national physical fitness test battery for children aged 3 to 6 years. The outcome was recorded in seconds. Lower values indicate better performance. The change score was calculated as the post-intervention time minus the baseline time.

Lower-limb explosive strength was assessed using the standing long jump from the Chinese national physical fitness test battery for children aged 3 to 6 years. The outcome was recorded in centimeters. Higher values indicate better performance. The change score was calculated as the post-intervention distance minus the baseline distance.

Upper-limb power and object-control ability were assessed using the tennis ball throw from the Chinese national physical fitness test battery for children aged 3 to 6 years. The outcome was recorded in meters or centimeters according to the test record form. Higher values indicate better performance. The change score was calculated as the post-intervention distance minus the baseline distance.

Coordination and lower-limb jumping ability were assessed using the double-foot continuous jump test from the Chinese national physical fitness test battery for children aged 3 to 6 years. The outcome was recorded in seconds. Lower values indicate better performance. The change score was calculated as the post-intervention time minus the baseline time.

Flexibility was assessed using the sit-and-reach test from the Chinese national physical fitness test battery for children aged 3 to 6 years. The outcome was recorded in centimeters. Higher values indicate better flexibility. The change score was calculated as the post-intervention distance minus the baseline distance.

Dynamic balance was assessed using the balance beam walking test from the Chinese national physical fitness test battery for children aged 3 to 6 years. The outcome was recorded in seconds. Lower values indicate better performance. The change score was calculated as the post-intervention time minus the baseline time.