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Background: During childhood, physical activity (PA) plays a fundamental role in motor development, as movement experiences during this critical period support the acquisition of both fine and gross motor skills (GMS) and foster an active lifestyle. This developmental phase, marked by regular engagement in PA and the progressive attainment of motor competence, has been consistently linked to a range of health benefits. Accordingly, early motor intervention programs have received considerable research attention for their demonstrated positive impact on children's motor skill development. Beyond such general approaches, more targeted strategies have also been explored, including programs aimed at increasing the amount of time devoted to PA within school settings. Prior studies have shown that incorporating structured exercise interventions-based on enjoyable, game-like activities-into the curriculum can significantly enhance children's fundamental motor skills.
Method and Materials: A total of 258 preschool children (128 boys, 130 girls) were assigned to either a gender-balanced experimental group participating in an innovative, daily physical education program (EG; n=125) or a control group following the standard institutional curriculum (CG; n=133). The average age of participants was 6.07±0.42 years (EG: 6.05±0.43; CG: 6.10±0.40). In EG, participants had organized physical activity 5 days per week (3 days led by physical education specialists, 2 days by preschool teachers), with each session lasting approximately 30-40 minutes. The CG continued their usual routine with structured physical activity two times per week (1 day led by a specialist, 1 day by a teacher). The program was implemented over a period of six months. The Test of Gross Motor Development-2 (TGMD-2) and Body Coordination Test for Children (KTK) were used to assess GMS, while the PREFIT battery was used to assess health-related physical fitness.
Aim: Тhe study aimed to empirically determine the effects of an experimental physical education program in preschool institutions on the development of motor skills and the improvement of health-related physical fitness in preschool-aged children.
Study design: The experimental physical education program presents a structured, daily physical activity intervention implemented within the standard curriculum of preschool institutions, aimed at enhancing children's motor and health-related development. The study aimed to determine the effects of this program, which lasted six months, on preschoolers' gross motor skills (GMS) and health-related physical fitness. The study presents an Interventional study to improve motor abilities, and the main objective is prevention. The study model is parallel with two groups.
Participants: The initial sample consisted of 323 preschool children, comprising all preparatory preschool groups enrolled at the Preschool Institution "Vera Gucunja" in Sombor. A randomized, pretest-posttest experimental design was applied, whereby half of the preparatory groups from the urban area were allocated to the Experimental Group (EG), participating in the six-month innovative physical education program, while the remaining groups, following the institution's standard curriculum, formed the Control Group (CG). Only healthy children whose parents or guardians were informed about the study and voluntarily provided written consent were included. Due to illness-related dropout over the course of the study, the final sample assessed at follow-up measurement was reduced to 258 children (EG: n=125, 48.45%; CG: n=133, 51.55%), with a mean age of 6.07±0.42 years (EG: 6.05±0.43; CG: 6.10±0.40). The study received approval from the institutional ethics committee at the Faculty of Sport and Physical Education, University of Novi Sad (ethical approval number: 142-451-2800/2018-01/01/2019).
Testing procedures
Secondary outcome: Anthropometric measures: Anthropometric data, including body height and body mass, were collected as part of the health-related fitness assessment. Following Martin's guidelines, body height was measured using a fixed anthropometer (GPM Anthropometer 100; DKSH Switzerland Ltd., Zurich, Switzerland; ± 0.1 cm). Body mass was measured with a digital balance (BC1000, Tanita, Japan; ± 0.1 kg), following the guidelines proposed by the International Biological Program (IBP).Body mass index (BMI) was calculated using the weight/height² (kg/m²) formula based on the measured height and weight values. Both measurements were taken twice, and both trials were recorded.
Primary outcome: TGMD-2 The Test of Gross Motor Development - 2 (TGMD-2) is a standardized test used to assess fundamental motor skills in children aged 3 to 10. It is widely regarded as a highly reliable and precise instrument for identifying children who lag behind their peers in motor skill development, evaluating individual progress, and assessing the effectiveness of motor intervention programs. The TGMD-2 assesses 12 fundamental motor skills divided into two subtests. The locomotor subtest consists of six skills: running, hopping, jumping, galloping, leaping, and sliding. The object control subtest includes six skills: striking a stationary ball, stationary dribbling, catching, kicking, throwing overhand, and underhand rolling. Each skill was verbally explained and demonstrated before testing, and participants were allowed one practice trial. Each skill was then performed twice, with locomotor skills assessed before object control skills, and each trial scored according to the test's performance criteria (1 point if the criterion was met, 0 if not). Testing took approximately 10-20 minutes per child and was performed indoors at each child's home kindergarten, with the exception of the shuttle run test, which, due to space constraints, was carried out at the "Partizan" Sokol Hall over three separate days. Total raw scores for each subtest and for the overall test ranged from 0 to 48.
Additional outcome: KTK (body coordination test) was used to assess general body coordination through four subtests: walking backwards along a beam, hopping on one leg over an obstacle, jumping sideways, and platform shifting. Each subtest was performed twice, with results converted into both raw and age- and sex-standardized (MQ) values.
Additional outcome: PREFIT battery (health-related physical fitness) The PREFIT battery was used to assess components of health-related physical fitness, including body composition (height, weight, BMI, waist circumference), muscular strength (handgrip strength, standing long jump), and cardiorespiratory/motor performance (4x10m running, shuttle run test). Testing followed a standardized order and protocol, with age-appropriate instructions and a narrative framework designed to engage preschool-aged children throughout the assessment.
Interventions: The EG participated in a six-month innovative physical education program, conducted daily (five days per week) during morning hours as part of the institution's directed activities, with sessions led by physical education specialists three days per week and by preschool teachers on the remaining two days. The program incorporated elements of ball sports (basketball, football, handball), athletics, gymnastics (developmental, corrective, rhythmic), children's yoga, children's aerobics, dance (folk and standard), and demonstrations of martial arts, with session duration adapted to age standards for directed activities (approximately 30-40 minutes for the preparatory preschool group). In contrast, the CG followed the institution's standard curriculum, engaging in structured physical activity two times per week (one day led by a specialist, one day by a teacher), in accordance with the general framework prescribed by the institution's annual work plan.
Statistical analyses: Statistical analyses were performed using SPSS software (version 20.0, IBM Corporation, USA). Descriptive statistics (mean, standard deviation, minimum, maximum, range, skewness, and kurtosis) were calculated for all variables. Normality of distribution was assessed using the Kolmogorov-Smirnov test and the coefficient of variation. Differences in motor skills and health-related fitness between the EG and CG at initial and final measurement were examined using multivariate analysis of variance (MANOVA) and univariate analysis of variance (ANOVA). Differences in the effects of the respective programs on motor skills and health-related fitness between groups were examined using multivariate analysis of covariance (MANCOVA) and univariate analysis of covariance (ANCOVA). Where deviations from normal distribution were detected, the non-parametric Mann-Whitney U test was applied. Statistical significance was set at p≤0.05.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Experimental (EG), participating in the six-month innovative physical education program | Experimental | The EG participated in a six-month innovative physical education program, conducted daily (five days per week) during morning hours as part of the institution's directed activities, with sessions led by physical education specialists three days per week and by preschool teachers on the remaining two days. The program incorporated elements of ball sports (basketball, football, handball), athletics, gymnastics (developmental, corrective, rhythmic), children's yoga, children's aerobics, dance (folk and standard), and demonstrations of martial arts, with session duration adapted to age standards for directed activities (approximately 30-40 minutes for the preparatory preschool group). |
|
| Control (CG) | No Intervention | Control group of participants CG followed the institution's standard curriculum, engaging in structured physical activity two times per week (one day led by a specialist, one day by a teacher), in accordance with the general framework prescribed by the institution's annual work plan. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Six-month daily PE program (5x/week), led by PE specialists and teachers, combining ball sports, gymnastics, athletics, yoga, aerobics, dance, and martial arts for preschoolers. | Behavioral | The EG participated in a six-month innovative physical education program, conducted daily (five days per week) during morning hours as part of the institution's directed activities, with sessions led by physical education specialists three days per week and by preschool teachers on the remaining two days. The program incorporated elements of ball sports (basketball, football, handball), athletics, gymnastics (developmental, corrective, rhythmic), children's yoga, children's aerobics, dance (folk and standard), and demonstrations of martial arts, with session duration adapted to age standards for directed activities (approximately 30-40 minutes for the preparatory preschool group). |
| Measure | Description | Time Frame |
|---|---|---|
| Test of gross motor development (tgmd-2): Locomotor Skills - Run | EQUIPMENT/CONDITIONS: A minimum of 50 feet of clear space and masking tape, chalk, or other marking device. DIRECTIONS: Mark off two lines 50 feet apart. Instruct student to "run fast" from one line to the other. PERFORMANCE CRITERIA: Brief period where both feet are off the ground! Arms in opposition to legs, elbows bent. Foot placement near or on line (not flat footed) Non-support leg bent approximately 90 degrees (close to buttocks). Expert scoring - the specific steps in scoring all items are listed below:
| Nine months |
| Test of gross motor development (tgmd-2): Locomotor skills - Gallop | EQUIPMENT/CONDITIONS: A minimum of 30 feet of clear space. DIRECTIONS: Mark off two lines 30 feet apart. Tell student to gallop from one line to the other three times. Tell student to gallop leading with one foot and then the other. PERFORMANCE CRITERIA: A step forward with the lead foot followed by a step with the trailing foot to a position adjacent to or behind the led foot. Brief period where both feet are off the ground. Arms bent and lifted to waist level. Able to lead with right and left foot. Expert scoring - the specific steps in scoring all items are listed below:
| Nine months |
| Test of gross motor development (tgmd-2): Locomotor skills - Hop | EQUIPMENT/CONDITIONS: A minimum of 15 feet of clear space. DIRECTIONS: Ask the student to hop three times, first on one foot and then on the other. PERFORMANCE CRITERIA: Foot of non-support leg is bent and carried in back of the body. Non-support leg swings in pendular fashion to produce force. Arms bent at elbows and swing forward on take-off. Able to hop on the right and left foot. Expert scoring - the specific steps in scoring all items are listed below:
|
| Measure | Description | Time Frame |
|---|---|---|
| Sex | The sex of the participants is recorded at the start of the study. | Nine months |
| Date of birth | The participant's date of birth is collected in order to calculate his age in years. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Dragan Marinkovic | University of Novi Sad, Faculty of Sport and Physical Education | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Faculty of sport and Physical Education, University of Novi Sad | Novi Sad | Vojvodina | 21000 | Serbia |
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| Nine months |
| Test of gross motor development (tgmd-2): Locomotor skills - Leap | EQUIPMENT/CONDITIONS: A minimum of 30 feet of clear space. DIRECTIONS: Ask the student to leap. Tell the student to take large steps by leaping from one foot to the other. PERFORMANCE CRITERIA: Take off on one foot and land on the opposite foot. A period where both feet are off the ground (longer than running). Forward reach with arm opposite the lead foot. Expert scoring - the specific steps in scoring all items are listed below:
| Nine months |
| Test of gross motor development (tgmd-2): Locomotor skills - Horizontal jump | EQUIPMENT/CONDITIONS: A minimum of 10 feet of clear space and masking tape or another marking device. • DIRECTIONS: Mark off a starting line on the floor, mat, or carpet. Have the student start behind the line. Instruct the student to "jump far." PERFORMANCE CRITERIA:
EXPERT SCORING:
| Nine months |
| Test of gross motor development (tgmd-2): Locomotor skills - skip | EQUIPMENT/CONDITIONS: A minimum of 30 feet of clear space and masking tape, or other marking device. DIRECTIONS: Mark off two lines 30 feet apart. Tell the student to skip from one line to the other three times. PERFORMANCE CRITERIA: A rhythmical repetition of the step-hop on alternate feet. Foot of non-support leg carried near surface during hop phase. Arms alternately moving in opposition to legs at about waist level. Expert scoring - the specific steps in scoring all items are listed below:
| Nine months |
| Test of gross motor development (tgmd-2): Locomotor skills - slide | EQUIPMENT/CONDITIONS: A minimum of 30 feet of clear space and masking tape or another marking device. DIRECTIONS: Mark off two lines 30 feet apart. Instruct the student to slide from one line to the other three times, facing the same direction. PERFORMANCE CRITERIA:
EXPERT SCORING:
| Nine months |
| Test of gross motor development (tgmd-2): Object control skill- two-hand strike | EQUIPMENT/CONDITIONS: A 4-6-inch light-weight ball and plastic bat. DIRECTIONS: Toss the ball softly to the student at about waist level. Tell the student to hit the ball "hard." Count only hose tosses that are between the student's waist and shoulders. PERFORMANCE CRITERIA: Dominant hand grips bat above nondominant hand. Nondominant side of body faces the tossed (feet parallel). Hip and spine rotation. Weight is transferred by stepping with front foot. Expert scoring - the specific steps in scoring all items are listed below:
| Nine months |
| Test of gross motor development (tgmd-2): Object control skill- stationary bounce | EQUIPMENT/CONDITIONS: An 8-10-inch playground ball and a flat hard surface. DIRECTIONS: Tell the student to bounce the ball three times using one hand. Make sure the ball is not underinflated. Repeat three separate trials. PERFORMANCE CRITERIA: Contact ball with one hand at about hip height. Pushes ball with fingers (not a slap). Ball contacts floor in front of (or to the outside of) foot on the side of the hand being used. Expert scoring - the specific steps in scoring all items are listed below:
| Nine months |
| Test of gross motor development (tgmd-2): Object control skill- catch | EQUIPMENT/CONDITIONS: A 6-8-inch sponge ball, 15 feet of clear space, masking tape or other marking device. DIRECTIONS: Mark off two lines 15 feet apart. The student stands on one line, and the ball is tossed from the other. Toss the ball underhand directly to the student with a slight arc, saying "catch it with your hands." Only count tosses between the student's shoulders and waist. PERFORMANCE CRITERIA:
EXPERT SCORING:
| Nine months |
| Test of gross motor development (tgmd-2): Object control skill- kick | EQUIPMENT/CONDITIONS: An 8-10-inch plastic or slightly deflated playground ball, 30 feet of clear space, masking tape or other marking device. DIRECTIONS: Mark off two lines-one 30 feet away from a wall and another 20 feet from the wall. Place the ball on the line nearest the wall and have the student stand on the other line. Instruct the student to kick the ball "hard" toward the wall. PERFORMANCE CRITERIA: Rapid continuous approach to the ball. Trunk inclined backward during ball contact. Forward swing of the arm opposite kicking leg. Follow-through by hopping on non-kicking foot. EXPERT SCORING: Require three trials. Observe and focus on performance criteria. Score "1" for correct performance on two out of three trials, otherwise score "0." | Nine months |
| Test of gross motor development (tgmd-2): Object control skill- overhand throw | EQUIPMENT/CONDITIONS: A tennis ball, a wall, and 25 feet of clear space. DIRECTIONS: Tell the student to throw the ball "hard" at the wall. PERFORMANCE CRITERIA: A downward arc of the throwing arm initiates the windup. Rotation of hip and shoulder to a point where the nondominant side faces an imaginary target. Weight is transferred by stepping with the foot opposite the throwing hand. Follow-through beyond ball release diagonally cross body toward side opposite throwing arm. Expert scoring - the specific steps in scoring all items are listed below:
| Nine months |
| Test of gross motor development (tgmd-2): Object control skill- underhand roll | EQUIPMENT/CONDITIONS: A tennis ball or a softball; two cones; tape; and 25 feet of clean space. DIRECTIONS: Place two cones 4 feet apart against a wall. Instruct the child to roll the ball between the cones with force. PERFORMANCE CRITERIA: Preferred hand swing, reaching behind the trunk while chest faces cones. Strides forward with foot opposite the preferred hand toward the cones. Bends knees to lower body. Releases ball close to the floor so ball does not bounce more than 4 inches high. Expert scoring - the specific steps in scoring all items are listed below:
| Nine months |
| Körperkoordinationstest für Kinder (KTK): Walking Backward (WB) | EQUIPMENT/CONDITIONS: Three balance beams, 3 m long, widths 6 cm, 4.5 cm, and 3 cm, placed parallel on a flat surface, 1 m apart. DIRECTIONS: As a practice trial, the child walks forward on the 6 cm beam. The child then walks backward on the same beam for three trials, then repeats on the 4.5 cm and 3 cm beams. PERFORMANCE CRITERIA: The child must maintain balance while walking backward, completing up to 8 steps per trial. TERMINATION CRITERIA: Each trial ends when the child loses balance and touches the ground. Expert scoring: Require three trials on each of the three beams (9 trials total). Record the number of successful steps (max 8) for each trial. Total score = sum of all 9 trials (maximum possible score: 72). | Nine months |
| Körperkoordinationstest für Kinder (KTK): Hopping for Height (HH) | EQUIPMENT/CONDITIONS: Three mats (2x1 m) in a row, 12 foam platforms (60x20x5 cm) at the second-third mat junction, forming obstacles 0-60 cm high. DIRECTIONS: From a one-legged run-up, the child hops twice on one leg, clears the platform(s), and hops twice more on the same leg after landing. PERFORMANCE CRITERIA: The child must land on the take-off leg and continue hopping on it for two more hops after clearance. TERMINATION CRITERIA: Ends after three errors (knocking the platform, or failing to continue on the take-off leg). Expert scoring: Attempt each obstacle height with both legs. Award 3 points (1st attempt), 2 points (2nd), 1 point (3rd). Total score = sum for both legs (maximum: 78, 39 per leg). | Nine months |
| Körperkoordinationstest für Kinder (KTK): Jumping Sideways (JS) | EQUIPMENT/CONDITIONS: A wooden slat (60 cm x 4 cm x 2 cm) and a stopwatch. DIRECTIONS: As a practice trial, the child performs 5 two-footed sideways jumps over the slat. The child then jumps sideways over the slat with both feet together as many times as possible within 15 seconds. The test is performed twice. PERFORMANCE CRITERIA: Each successful two-footed jump over the slat is counted. TERMINATION CRITERIA: The trial ends when the 15-second period elapses. Expert scoring - the specific steps in scoring all items are listed below: Require the subject to perform two trials of 15 seconds each. The examiner counts and records the number of successful jumps for each trial. The total score is the sum of successful jumps from both trials. | Nine months |
| Körperkoordinationstest für Kinder (KTK): Moving Sideways (MS) | EQUIPMENT/CONDITIONS: Two wooden platforms (25 cm x 25 cm x 5.7 cm) and a stopwatch. DIRECTIONS: The child stands on one platform, moves the second platform to the side in the intended direction, steps onto it, and repeats the sequence as many times as possible within 20 seconds. The test is performed twice. PERFORMANCE CRITERIA: Each complete platform transfer and step is counted. TERMINATION CRITERIA: The trial ends when the 20-second period elapses. Expert scoring - the specific steps in scoring all items are listed below: Require the subject to perform two trials of 20 seconds each. The examiner counts and records the number of platform transfers for each trial. The total score is the sum of transfers from both trials. | Nine months |
| PREFIT: Body Height and Body Mass (BMI) | EQUIPMENT/CONDITIONS: Digital scale and stadiometer. DIRECTIONS: For body mass, the child stands barefoot at the center of the scale, weight evenly distributed, arms at the sides. For body height, the child stands barefoot on the stadiometer, heels touching the vertical board, with the head positioned in the Frankfurt horizontal plane. PERFORMANCE CRITERIA: The child must remain still, without shoe wear or heavy clothing, during measurement. Expert scoring - the specific steps in scoring all items are listed below: Require the subject to perform two trials for both height and weight. Record body mass to the nearest 100 g (e.g., 28.0 kg) and body height to the nearest millimeter (e.g., 100.3 cm). Calculate BMI using the formula: weight (kg) / height² (m²). | Nine months |
| PREFIT: Waist Circumference | EQUIPMENT/CONDITIONS: A non-elastic (tailor's) measuring tape. DIRECTIONS: The child stands upright, abdomen relaxed, arms at the sides, feet together. The examiner places the tape horizontally at the level of the navel, at the end of a normal exhalation. PERFORMANCE CRITERIA: The tape must not compress the skin and must not be placed over clothing. Expert scoring - the specific steps in scoring all items are listed below: Require the subject to perform two non-consecutive trials. Record both results to the nearest 0.1 cm (e.g., 60.7 cm). | Nine months |
| PREFIT: Standing Long Jump | EQUIPMENT/CONDITIONS: A non-slip surface marked with a measuring track in centimetres, a starting line, and a measuring tape. DIRECTIONS: The child stands behind the line, feet shoulder-width apart, bends the knees, swings the arms, and jumps forward as far as possible, landing on both feet. PERFORMANCE CRITERIA: The child must attempt to land with both feet simultaneously and maintain an upright position. Expert scoring - the specific steps in scoring all items are listed below: Require the subject to perform three trials. Measure the distance from the take-off line to the nearest point of contact (heels). Record the best of the three trials, in centimetres (e.g., 106 cm). | Nine months |
| PREFIT: 4x10m Running Test | EQUIPMENT/CONDITIONS: A clean, non-slip surface, stopwatch, four cones, and adhesive tape marking two parallel lines 10 m apart. DIRECTIONS: On the starting signal, the child runs as fast as possible to the opposite line, touches the examiner's hand, and returns, repeating the sequence for a total of four 10 m lengths. PERFORMANCE CRITERIA: Both feet must cross each line on every pass; the child must run in a straight line without slipping. Expert scoring - the specific steps in scoring all items are listed below: Require the subject to perform two trials. Record the best time, in seconds, rounded to one decimal place. | Nine months |
| PREFIT: Shuttle Run Test | EQUIPMENT/CONDITIONS: A gymnasium or open space of at least 20 m, four cones, measuring tape, and an audio player with the recorded test protocol. DIRECTIONS: The child runs between two lines 20 m apart, pacing with an audio signal that starts at 6.5 km/h and increases by 0.5 km/h per minute (one minute per level). PERFORMANCE CRITERIA: The child must reach the line in time with the signal; the test ends when the child fails to reach the line in time with the signal on two consecutive occasions, or stops due to fatigue. Expert scoring - the specific steps in scoring all items are listed below:
| Nine months |
| Additional test: Sit & Reach (Flexibility) | EQUIPMENT/CONDITIONS: A sit-and-reach box. DIRECTIONS: The child sits on the floor with legs extended and together, arms extended forward, one palm placed over the back of the other hand, and reaches forward as far as possible with the middle fingers, without bouncing. PERFORMANCE CRITERIA: The legs must remain fully extended throughout the task. Expert scoring - the specific steps in scoring all items are listed below:
| Nine months |
| Additional test: 30-Second Sit-Ups (Trunk Muscular Endurance) | EQUIPMENT/CONDITIONS: A stopwatch and a mat. DIRECTIONS: The child lies supine on the mat, knees bent at 90°, feet hip-width apart, arms crossed over the chest with hands on opposite shoulders, feet held by the examiner; on the starting signal, the child performs as many sit-ups as possible in 30 seconds (elbows touching the thighs, then returning to the supine position). PERFORMANCE CRITERIA: Each repetition must be correctly executed (elbows touch thighs, back returns to the mat). Expert scoring - the specific steps in scoring all items are listed below:
| Nine months |
| Nine months |
| Weight | The weight of the participants is analyzed in kilograms. | Nine months |
| Height | The height of the subject is determined in meters. | Nine months |
| Body Mass Index (BMI) | The participant's BMI is calculated from his height and weight. | Nine months |
| Adherence | Adherence to the program is calculated from the record of the percentage of attendance at the intervention sessions. | Nine months |
| ID | Term |
|---|---|
| D009043 | Motor Activity |
| ID | Term |
|---|---|
| D001519 | Behavior |
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| ID | Term |
|---|---|
| D006173 | Gymnastics |
| D015013 | Yoga |
| D015444 | Exercise |
| ID | Term |
|---|---|
| D009043 | Motor Activity |
| D009068 | Movement |
| D009142 | Musculoskeletal Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |
| D026441 | Mind-Body Therapies |
| D000529 | Complementary Therapies |
| D013812 | Therapeutics |
| D026443 | Spiritual Therapies |
| D026241 | Exercise Movement Techniques |
| D026741 | Physical Therapy Modalities |
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