Objectives: Mastery in-fundamental motor skills (FMS) is associated with increased physical activity (PA) in school-aged children; however, there is limited research on pre-schoolers (3-5 years). We aimed to evaluate interventions for improving FMS as well as PA. Design/Methods: A search of electronic databases was conducted for controlled trials using PA interventions with FMS as outcomes in healthy pre-schoolers. Standardised mean difference (SMD), 95% confidence intervals and publication bias were calculated for each outcome using Revman 5.3. Results: Twenty trials met inclusion criteria. In total, 4255 pre-schoolers were analysed with 854 completing a FMS intervention. Studies were categorised into three groups (i) Teacher-Led (TL)(n =13); (ii) Child-Centred (CC)(n = 6) and (iii) Parent-Led (PL)(n = 1). Mean age was 4.3 +/- 0.4 years, with equal gender distribution. Interventions ran for 21 +/- 17 weeks, 3 +/- 1 times per week for 35 +/- 17 minutes. TL interventions significantly improved overall FMS (SMD = 0.14[0.06, 0.21]; p = 0.0003), object control (SMD = 0.47[0.15, 0.80]; p = 0.004), and locomotor skills (SMD = 0.44[0.16, 0.73]; p = 0.002), whereas CC interventions were not significant. There was a small, non-significant reduction in sedentary time (SMD = -0.35[-0.80, 0.10]; p = 0.12), and a large non-significant increase in PA (SMD = 0.79[-0.83, 2.41]; p = 0.34). Conclusion: PA interventions improve FMS in pre-schoolers; however, due to limited research, more study is needed on CC interventions. Targeting FMS development in pre-schoolers may promote higher PA levels and reduce sedentary time, however more study is needed. (C) 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.