Factors predicting physical activity among children with special needs

Relationship between Emotional Support for Parents and Autistic Children's Participation in Social and Physical Activities

The purpose of this study was to determine if parents receiving emotional support is positively correlated with children's participation in physical and social activities and if such a correlation exists between parental emotional support in children labeled as autistic. Data were drawn from 30,501 children aged 6 to 17 years in the 2020 National Survey of Children's Health database and analyzed using a retrospective cross-sectional approach based on multivariate linear regression models. Results showed parental emotional support was statistically significantly correlated with children's physical and social activity in the total sample but was not significant for the emotional support of parents with autistic children. The findings suggest that other issues must be considered as contributing factors for parents of autistic children in relation to social and physical activity participation.

The interaction between social determinants of health, health behaviors, and child's intellectual developmental diagnosis

INTRODUCTION

Social determinants of health (SDOH) may impact caregivers' ability to implement evidence-based health practices at home during early childhood, especially in families with children with intellectual and developmental disabilities (IDD). Therefore, we examined the influence of SDOH and children's diagnosis (typically developing [TD], Down syndrome [DS], autism) on caregiver's self-report of meeting evidence-based health practices.

METHODS

Caregivers (n=172) of children ages 2-6 years (TD: n=93, DS: n=40, autism: n=39) completed an online survey on SDOH and health practices related to child nutrition (CN), physical activity (PA), outdoor play (OP), and screen time (ST). A total SDOH score was computed by assigning 1 point for each favorable SDOH metric (range 0-13). Linear regressions were used to examine associations between SDOH and CN, PA, OP, ST health practices and the moderating effect of IDD diagnosis.

RESULTS

Most caregivers were non-Hispanic White (84.3%), female (76.7%), 18-35 years old (55.2%), and married (89.5%). The DS group had the lowest SDOH score (mean = 8.4±1.0) compared to autism (mean = 10.1±1.0) and TD (mean = 11.0±0.9). No family scored 100% in evidence-based practices for any health practice. SDOH score was significantly associated with evidence-based practices met score for CN (b = 1.94, 95% CI = 0.84, 3.04; p = 0.001) and PA (b = 4.86, 95% CI = 2.92, 6.79; p <0.0001). Moderation analysis showed no association in the DS and autism groups between SDOH score and CN percent total score, or between SDOH score and CN, PA, and OP for percent evidence-based practices met. SDOH score was also not associated with OP percent total score for the DS group.

CONCLUSIONS

This study highlights the differential influence of SDOH on caregivers' implementing health practices in families with children of different IDD diagnoses. Future research is needed to understand impacts of SDOH on non-typically developing children.

Impact of COVID-19 on Physical Activity in Families Managing ADHD and the Cyclical Effect on Worsening Mental Health

Physical activity supports symptom management in children with ADHD and reduces the mental health burden associated with caregiving for children with ADHD. Survey-based research shows that COVID-19 reduced physical activity among diverse populations. This study used a qualitative approach situated within a socioecological framework to (1) understand how COVID-19 impacted physical activity of children with ADHD and their caregivers, to (2) identify barriers to their physical activity, and to (3) identify potential areas of support. Thirty-three participants were interviewed between October 2020 and January 2021. Content analysis revealed that physical activity declined for children and caregivers; significant barriers were social isolation and rising intrapersonal difficulties such as diminishing self-efficacy and energy levels and increased mental health difficulties. Worsening mental health further alienated caregivers and children from physical activity, undermining its protective effects on ADHD symptom management and mental wellbeing. Participants identified needing community support programs that offer virtual, live physical activity classes as well as psycho-emotional support groups. There is vital need to support physical activity opportunities during high-stress situations in families managing ADHD to buffer against diminishing mental wellbeing. This will promote further physical activity engagement and allow families to reap the cognitive, psychological, and emotional benefits.

Effects of Exercise Programs on Functional Capacity and Quality of Life in People With Acquired Brain Injury: A Systematic Review and Meta-Analysis

OBJECTIVE

The aims of this systematic review and meta-analyses were to evaluate the effects of exercise on the functional capacity and quality of life (QoL) of people with acquired brain injury (ABI) and to analyze the influence of training variables.

METHODS

Five electronic databases (MEDLINE, Cochrane Library, CINAHL, SportDiscus, and Web of Science) were searched until October 2021 for clinical trials or experimental studies examining the effects of exercise on the functional capacity and QoL in adults with ABI and comparing exercise interventions with non-exercise (usual care).

RESULTS

Thirty-eight studies were evaluated. A total sample of 2219 people with ABI (exercise, n = 1572; control, n = 647) were included in the quantitative analysis. A greater improvement was observed in walking endurance (z score = 2.84), gait speed (z score = 2.01), QoL physical subscale (z score = 3.42), and QoL mental subscale (z score = 3.00) was observed in the experimental group than in the control group. In addition, an improvement was also observed in the experimental group in the "Timed Up and Go" Test scores and balance without differences from the control group. Significant interactions were also observed between the rehabilitation phases, type, frequency and volume of training, and overall effects.

CONCLUSION

The results suggest that exercise improves functional capacity and QoL regardless of model training, highlighting the effectiveness of long-term exercise that includes short sessions with components such as strength, balance, and aerobic exercise.

IMPACT

The results shown in this systematic review with meta-analysis will allow physical therapists to better understand the effects of training on people with ABI.

Promoting the Participation of Children and Adolescents With Disabilities in Sports, Recreation, and Physical Activity

The benefits of physical activity are likely universal for all children, including children and adolescents with disabilities (CWD). The participation of CWD in physical activity, including adaptive or therapeutic sports and recreation, promotes inclusion, minimizes deconditioning, optimizes physical functioning, improves mental health as well as academic achievement, and enhances overall well-being. Despite these benefits, CWD face barriers to participation and have lower levels of fitness, reduced rates of participation, and a higher prevalence of overweight and obesity compared with typically developing peers. Pediatricians and caregivers may overestimate the risks or overlook the benefits of physical activity in CWD, which further limits participation. Preparticipation evaluations often include assessment of health status, functional capacity, individual activity preferences, availability of appropriate programs, and safety precautions. Given the complexity, the preparticipation evaluation for CWD may not occur in the context of a single office visit but rather over a period of time with input from the child's multidisciplinary team (physicians, coaches, physical education teachers, school nurses, adaptive recreation specialists, physical and occupational therapists, and others). Some CWD may desire to participate in organized sports to experience the challenge of competition, and others may prefer recreational activities for enjoyment. To reach the goal of inclusion in appropriate physical activities for all children with disabilities, child, family, financial, and societal barriers to participation need to be identified and addressed. Health care providers can facilitate participation by encouraging physical activity among CWD and their families during visits. Health care providers can create "physical activity prescriptions" for CWD on the basis of the child's preferred activities, functional status, need for adaptation of the activity and the recreational opportunities available in the community. This clinical report discusses the importance of participation in sports, recreation, and physical activity for CWD and offers practical suggestions to health care providers.

Improvements in Swim Skills in Children with Autism Spectrum Disorder Following a 5-Day Adapted Learn-To-Swim Program (iCan Swim)

Drowning is one of the leading causes of death in children and teenagers. Individuals with autism spectrum disorder (ASD) are at increased risk for drowning. Improvements in swim skills have been observed in children with ASD participating in learn-to-swim programs. However, it is unclear if age, co-occurring conditions, and/or the dose of practice influence swim skills in this population. To this end, a secondary data analysis of iCan Swim program data was conducted to determine the efficacy of the 5-day adapted learn-to-swim program for a cohort of children with ASD ages 3-16 years (n = 86). Participant swim level was evaluated at the start and end of the program. Linear mixed-effects regression was used to examine the effects of Time (start/end), Age, Dose of Swim Practice (i.e., total time-time out of the water), and ADHD status on the overall swim level. Participants significantly increased the swim level from the beginning to the end of the program (B = 0.63, 95% CI = 0.52-0.74), and participants with ASD and co-occurring ADHD had greater swim levels regardless of Time than those without ADHD (B = 0.45, 95% CI = 0.05-0.84). Overall, iCan Swim is effective in improving the swim skills of children and teenagers with ASD.

Physical Activity Among Adults With Autism: Participation, Attitudes, and Barriers

Children and adolescents with autism spectrum disorder (ASD) have shown have low levels of physical fitness, increasing risks for health-related problems associated with inactivity, such as being overweight, when compared with typically developing children. Few studies have examined physical activity (PA) among adults with ASD. This U.S.-based study examined participation in and attitudes and barriers toward PA among adults with ASD and their peers without ASD. We used standardized existing scales to survey participants for data regarding their frequency of engagement in weekly PA (strenuous, moderate, light), attitudes toward PA, expectations of others, perceived behavioral control, intention toward PA, and perceived PA barriers. Findings indicated that, on average, the ASD group compared with the comparison group reported (a) less frequent strenuous or moderate PA, (b) less positive attitudes toward PA, (c) less perceived behavioral control or ease of performing PA, and (d) more PA barriers. There was also evidence that the ASD group reported less PA intent, but there was no difference between groups regarding beliefs about others' PA expectations for them. These findings suggest a need for more PA for adults with ASD, particularly because PA has potential to attenuate such ASD challenges as anxiety, stress, and sleeping difficulties.

Physical Activity Assessment and Counseling in Pediatric Clinical Settings

Physical activity plays an important role in children's cardiovascular health, musculoskeletal health, mental and behavioral health, and physical, social, and cognitive development. Despite the importance in children's lives, pediatricians are unfamiliar with assessment and guidance regarding physical activity in children. With the release of the 2018 Physical Activity Guidelines by the US Department of Health and Human Services, pediatricians play a critical role in encouraging physical activity in children through assessing physical activity and physical literacy; providing guidance toward meeting recommendations by children and their families; advocating for opportunities for physical activity for all children in schools, communities, and hospitals; setting an example and remaining physically active personally; advocating for the use of assessment tools and insurance coverage of physical activity and physical literacy screening; and incorporating physical activity assessment and prescription in medical school curricula.

The perspectives of parents of youth with disabilities toward physical activity: A systematic review

BACKGROUND

Parents' perceptions of physical activity (PA), in particular, are critically important because children with disabilities are often dependent on their families to be able to engage in physical activities. Thus, adapted physical activity scholars have acknowledged the need for research addressing the perceptions of parents of youth with disabilities regarding their child's PA engagement.

PURPOSE

The purpose of this review was to examine published research literature pertaining to parents' perspectives toward physical activity of youth with disabilities by describing study characteristics and major findings.

METHODS

Electronic database searches were conducted to identify relevant articles published between January 2007 and January 2018.

RESULTS

Thirty-two articles met all inclusion criteria, and relevant data such as participant characteristics, theories, measurements, and dependent variables were extracted from them. Of the 32 studies, 26 were descriptive, and six were correlational. Seventeen studies explicitly stated a theoretical or conceptual framework.

CONCLUSIONS

Major findings suggest that parents have reported multiple motives to engage their children with disabilities in physical activity. However, numerous barriers (e.g., lack of program, lack of time, children's disability) were reported that negatively impact physical activity participation. As such, parents are calling for the need for training provided by qualified professionals to enhance participation for their children with disabilities.

"The PIT Experience": A Young Adult with Autism Spectrum Disorder's Opinion of how a Wellness Program Changed her Life

Piece it Together (PIT) is a comprehensive wellness program designed for transitional age youth with Autism Spectrum Disorder and mild neurodevelopmental disabilities that focuses on exercise, nutrition, socialization, and stress-reduction. The PIT Summer Program is a 6-week program, consisting of 90-min classes, twice a week. Each class incorporates 45-min of exercise and health and wellness lessons in goal setting, nutrition, bones and muscle anatomy, and stress management. The PIT program has successfully brought together a unique group to build friendships and make healthier lifestyle choices. One female participant has felt positively impacted and many of her in-class achievements have translated to greater success in work and school environments. She describes the impacts of the PIT program in this letter.

Does physical activity differ between youth with and without intellectual disabilities?

BACKGROUND

Children and youth with intellectual disabilities (ID) are known to face obstacles to physical activity participation, yet the activity patterns of this population are not well characterized.

OBJECTIVE/HYPOTHESIS

In this study, time spent in moderate to vigorous physical activity (MVPA), type, and frequency of participation in physical activities were assessed in youth with ID and in a comparison group of typically developing (TD) youth.

METHODS

Weekly participation in MVPA in 38 youth with ID and 60 TD youth was assessed via accelerometry. Participants were also administered an interview about the frequency and type of physical activities they engaged in over the past year.

RESULTS

After adjusting for age and sex, youth with ID spent significantly less time in MVPA (33.5 vs. 46.5 min/day, p = 0.03) and were less likely to meet the US Physical Activity Guidelines than TD youth (6% vs. 29%, p = 0.01). Although time in MVPA was lower in youth with ID, females with ID participated in physical activities more frequently than TD females (47.1 vs. 28.2 times/month, p = 0.008) and also reported engaging in a greater variety of physical activities (7.8 vs. 5.2 activities/year, p = 0.01). No differences between males in the frequency of physical activity participation or the number of activities performed were observed. Both groups reported walking/hiking and active video as top activities.

CONCLUSIONS

Findings emphasize the need for targeted efforts to increase MVPA in youth with ID.

An evaluation of the implementation of a parent-led, games-based physical activity intervention: the Active Play at Home quasi-randomized trial

NCT02058342. Registered 6 February 2014 retrospectively registered.

Interventions to promote physical activity for youth with intellectual disabilities

OBJECTIVE

To describe interventions designed to promote physical activity for youth with intellectual disabilities.

MATERIALS AND METHODS

A systematic review of nine databases until January 31, 2015 identified 213 citations. The inclusion criteria were: a) the study sample consisted of youth with intellectual disabilities, b) the study implemented an intervention to initiate, increase, or maintain physical activity, and c) quantitative or qualitative data were used to report the effectiveness of the intervention. Eleven articles from the 213 citations met this criterion.

RESULTS

Nine studies reported significant increases in physical activity behavior.

CONCLUSIONS

Conclusions cannot be made regarding intervention components that impacted outcome variables, if the observed effects were specifically due to the intervention or if interventions could be maintained long-term. To advance the knowledge base in this area, a concerted effort should be made to increase rigor in study conceptualization and research design.

Patterns of sedentary time and ambulatory physical activity in a Danish population of girls and women with Rett syndrome

BACKGROUND

Rett syndrome (RTT) is a rare neurodevelopmental disorder leading to multiple disabilities and high dependency on caregivers. This study aimed to: (1) describe the patterns of sedentary time and daily steps and (2) identify the association of individual and environmental characteristics with sedentary time.

METHODS

All Danish females with RTT older than 5 years of age and with a MECP2 mutation were invited to participate. The activPAL and StepWatch Activity Monitor (SAM) were worn by participants for at least four days. Sedentary time and step counts were plotted by time to examine daily activity patterns. Associations between sedentary time and individual and environmental covariates were assessed with linear regression models.

RESULTS

The median (interquartile range) age of participants was 22.0 (14.3-36.5) years. On average 83.3% (standard deviation 13.9%) of waking hours were spent in sedentary behaviours (n = 48) and the median (interquartile range) daily step count was 5128 (2829-7704) (n = 28). Females older than 33.5 years, and those unable to walk independently were more sedentary.

CONCLUSIONS

This study demonstrated high levels of sedentary time and low daily step counts in a Danish population of females with RTT. Advancing age and lower walking skills were associated with higher levels of sedentary time. Implications for Rehabilitation Sedentary lifestyles in individuals with disabilities have a negative impact on health and quality of life. High levels of sedentary time and low daily step counts were demonstrated in a Danish population of females with Rett syndrome. Advancing age and inability to walk independently were strongly associated with higher levels of sedentary time in females with Rett syndrome. Understanding patterns of sedentary behaviour and physical activity can aid health care professionals in developing health-promoting physical activity interventions.

Assessing Parent Perceptions of Physical Activity in Families of Toddlers With Neurodevelopmental Disorders: The Parent Perceptions of Physical Activity Scale (PPPAS)

PURPOSE

The purpose of this study was to examine a new tool (PPPAS = Parent Perceptions of Physical Activity Scale-Preschool) developed to study parental perceptions of physical activity (PA) among parents of toddler and preschool age children.

METHOD

143 children (mean age 31.65 months; 75% male) and their parents were recruited from a neurodevelopmental clinic. Parents completed questionnaires, and both a psychologist and a physician evaluated the children. Eighty-three percent of the children received a diagnosis of Autism Spectrum Disorder; 20% of the children had a BMI > 85th percentile. Analyses were conducted to evaluate the reliability, concurrent validity, discriminant validity, and predictive validity of PPPAS scores.

RESULTS

Results supported a two-factor structure: Perceptions of the Benefits of PA and the Barriers to PA. The internal consistency of scores was good for both PPPAS subscales, derived from the two factors. Parent perceptions of barriers to PA were significantly correlated with delays in overall adaptive functioning, daily living skills, socialization, and motor skills. When a child's motor skills were delayed, parents were less likely to believe PA was beneficial and perceived more barriers to PA. Parent perceptions of barriers to PA predicted parent-reported weekly unstructured PA and ratings of how physically active their child was compared with other children.

CONCLUSION

We present the PPPAS-Preschool for use in pediatric exercise research and discuss potential applications for the study of parent perceptions of PA in young children.

Physical activity of rurally residing children with a disability: A survey of parents and carers

BACKGROUND

Children residing in rural areas face unique barriers to physical activity participation. Further, while children with a disability who reside in metropolitan areas face barriers hindering physical activity, rurally residing children with a disability may face the augmented combination of these barriers that could have negative health implications. Parents are often the key advocates for children with disabilities and are likely to have valuable insight into the opportunities and barriers to physical activity for their child.

OBJECTIVE

The aim of this study was to investigate parents' perceptions of physical activity opportunities for their child with a disability in a rural area.

METHODS

A mixed method survey examining parent's perceptions of their child's physical activity and possible barriers to participation was mailed to rurally residing parents of children with a disability. Quantitative data were analyzed descriptively using frequencies and proportions. Qualitative data were analyzed using qualitative content analysis.

RESULTS

There were 34 completed surveys, a response rate of 37%. Participants' responses indicated 74% of children were not meeting daily recommendations of physical activity. Participation barriers including emotional, physical and environmental issues. Three main themes emerged from qualitative data; segregation, access to facilities and resources and barriers specific to the child.

CONCLUSION

The children in this study were from rural areas and face similar barriers to children in metropolitan areas. However, they are also confronted with the same barriers children without a disability in rural areas face, participating in physical activity. This may have detrimental effects on their health and development.

Translating benefits of exercise on depression for youth with autism spectrum disorder and neurodevelopmental disorders

Young adults with Autism Spectrum Disorder (ASD) are at increased risk of poor health and depressive symptoms due to difficulty with communication, limited interests, sensory deficits, and sedentary lifestyles. The Piece It Together program was developed to provide socialization and wellness goals for teens and young adults with ASD and other mild neurocognitive deficits. The curriculum includes strength and endurance training, nutrition education, and stress reduction techniques to promote healthy lifestyle choices. Twelve participants, aged 15-27, attended 90-minute classes at the MUSC Wellness Center twice a week for six weeks and were encouraged to increase their activity level every day. The Patient Health Questionnaire (PHQ-9) was administered to each participant at the first and last class. Results showed significantly decreased PHQ-9 depression scores at the end of the program, from mild (7.69) to minimal depression (3.42) (p=0.000063). Overall, the activities completed in the Piece It Together program successfully unified this group to promote healthy lifestyle choices and resulted in improved mood.

Predictors of Obesity in a US Sample of High School Adolescents With and Without Disabilities

BACKGROUND

Childhood obesity is a major public health concern. Children with disabilities have a higher prevalence of obesity.

OBJECTIVE

We examined factors associated with obesity within a cross-sectional study of US adolescents with and without disabilities.

METHODS

Data were obtained from the 2011 Youth Risk Behavior Survey. Logistic regression models were fitted to assess effects of dietary habits, physical activity, and unhealthy weight control behaviors on obesity. Effect modification by disability status was examined.

RESULTS

Twenty percent (1986 of 9775 participants) reported a disability. Adolescents with disabilities were more likely to be obese (odds ratio [OR] = 1.7; 95% confidence interval [CI]: 1.3-2.1) and have at least 1 unhealthy weight control behavior (OR = 2.0; 95% CI: 1.6-2.5), and were less likely to be physically active (OR = 0.5; 95% CI: 0.4-0.6). Lack of physical activity, increased television watching/video game playing, and unhealthy weight loss behaviors were significantly associated with obesity regardless of disability status (p-for-interaction >.05).

CONCLUSIONS

Successful obesity interventions should target diet, physical activity, and weight control among adolescents with disabilities. Understanding barriers to healthier diet and physical activity for this population is critical to developing effective obesity prevention programs and reducing the prevalence of unhealthy weight control behaviors.

Benefits of a Culturally Tailored Health Promotion Program for Latino Youth With Disabilities and Their Families

Little research is available about youth with disabilities, who experience numerous inequalities in health outcomes compared with youth without disabilities. Youth with disabilities experience many environmental and attitudinal barriers in maintaining healthy lifestyles, which put them at risk for obesity. Strong evidence has suggested that obesity rates are higher among youth with disabilities than among their nondisabled peers. The purpose of this study was to implement and examine the benefits of a culturally tailored healthy lifestyles program for Latino youth with disabilities and their families. Several cultural adaptations were made to align with the target population’s cultural norms. Seventeen Latino families identified 67 behaviors they wanted to change or new habits they wanted to establish. The postassessment data showed that several family routines improved, and families reported engaging in many of the healthy habits they had identified for themselves. Implications of culturally appropriate and accessible programming are discussed.

Enjoyment, Barriers, and Beliefs About Physical Activity in Adolescents With and Without Autism Spectrum Disorder

The authors compared physical activity enjoyment, perceived barriers, beliefs, and self-efficacy between adolescents with autism spectrum disorder (ASD) and typically developing (TD) adolescents. A questionnaire was verbally administered to 35 adolescents with ASD and 60 TD adolescents. Compared with TD adolescents, fewer adolescents with ASD enjoyed team sports (65% vs. 95%, p < .001) and physical education (84% vs. 98%, p = .02). A greater proportion of adolescents with ASD perceived that physical activities were too hard to learn (16% vs. 0%, p < .01), and fewer believed that physical activity was a way to make friends (68% vs. 97%, p < .001). Fewer adolescents with ASD preferred to do physical activity in their free time (25% vs. 58%, p < .01). Most adolescents with ASD felt that physical activity is fun (84%), but the proportion was lower than in TD adolescents (98%, p = .03). Some perceptions about physical activity were similar between the 2 groups, but differences identified may inform program development.

Physical Activity Enjoyment, Perceived Barriers, and Beliefs Among Adolescents With and Without Intellectual Disabilities

BACKGROUND

Youths with intellectual disabilities (ID) exhibit low levels of physical activity, but the underlying contributors to behavior are unclear. We compared physical activity enjoyment, perceived barriers, beliefs, and self-efficacy among adolescents with ID and typically developing (TD) adolescents.

METHODS

A questionnaire was administered to 38 adolescents with ID (mean age, 16.8 years) and 60 TD adolescents (mean age, 15.3 years). Of the original 33 questionnaire items, 23 met the test-retest reliability criteria and were included in the group comparisons.

RESULTS

Fewer adolescents with ID reported that they have someone with whom to do physical activity (64% vs 93%: P < .001), and a greater percentage of adolescents with ID perceived that physical activities were too hard to learn (41% vs 0%; P < .001). Fewer adolescents with ID believed that physical activity would be good for their health (92% vs 100%; P = .05). More adolescents with ID reported a dislike of individual physical activities (P = .02). A large percentage of adolescents with ID (84%) responded that they were good at doing physical activities, but the difference between groups was only of borderline significance (95% of TD adolescents, P = .06).

CONCLUSIONS

Adolescents shared many of the same perceptions about physical activity, but some important differences between groups were identified.

Obesity Prevention for Children with Developmental Disabilities

The prevention of obesity in children with DD is a pressing public health issue, with implications for health status, independent living, and quality of life. Substantial evidence suggests that children with developmental disabilities (DD), including those with intellectual disabilities (ID) and autism spectrum disorder (ASD), have a prevalence of obesity at least as high if not higher than their typically developing peers. The paper reviews what is known about the classic and unique risk factors for childhood obesity in these groups of children, including dietary, physical activity, sedentary behavior, and family factors, as well as medication use. We use evidence from the literature to make the case that primary prevention at the individual/family, school and community levels will require tailoring of strategies and adapting existing intervention approaches.