Why We Must Prioritize Equitable Access to Physical Activity for Children with Disabilities
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Why We Must Prioritize Equitable Access to Physical Activity for Children with Disabilities

Marquell Johnson, Ph.D.; Vincenzo Nocera, Ph.D.; Navin Kaushal, Ph.D.; Lauren Simon, M.D., FACSM; Rebecca Hasson, Ph.D., FACSM, and the ACSM Strategic Health Initiative on Health Equity | Mar 22, 2021

active boy in wheelchair with bat and ballProviding children with disabilities equal access to quality education is a central tenet of the Individuals with Disabilities Education Act (IDEA). This four-part American legislation governs how states, schools and public agencies provide special education and related services to more than 6.5 million children across the country. Within this legislation, students are entitled to free and appropriate public education, including specially designed instruction, supplementary aids and related services based on their Individualized Education Program goals. IDEA is intended to meet the unique needs of a child with a disability at no cost to parents. Despite these important legislative wins, children with disabilities are often overlooked and systematically excluded from physical activity opportunities provided at schools.

Current evidence suggests that children with disabilities are 4.5 times less likely to engage in physical activity compared to children without disabilities. Contributing factors to this disparity include:

  • The general population has a lack of understanding of children’s ability level and fear of potential injury. For example, the play behaviors of children with disabilities differ from their peers, as they engage in more solitary play than those without disabilities.
  • Many playgrounds are not adapted (i.e. equipped with wayfinding systems, unitary surfacing, flush transitions, sensory elements, etc.) to meet the needs of children with disabilities. This potentially limits them from engaging in spontaneous physical activity during recess.
  • A scarcity of adapted physical education programs and curricula for students with disabilities is commonly documented. An increased emphasis on competition rather than inclusion during physical education class significantly hinders physical activity participation among this group.
  • Adequate training to plan and implement inclusive physical activity and recreation programs for children with disabilities is lacking.

We must identify and acknowledge these barriers to equitable access to school-based physical activity opportunities, and develop targeted strategies to promote health and wellness in students who are underserved. More importantly, in the current COVID-19 environment there is an urgent need to provide resources and strategies to families of children with disabilities. While schools across the nation have transitioned to virtual learning, these resources can prevent further declines in physical activity participation.

Call-to-action: Universal and tailored approaches to promote equitable physical activity opportunities in schools

The school setting is a pragmatic solution to providing quality physical education and increasing access to physical activity opportunities for children with disabilities. During the academic year (nine to 10 months), children spend most of their waking hours at school. School-based programming provides structured physical activity opportunities for children with disabilities to learn and develop motor skills through quality physical education, and offer a spontaneous chance to practice motor skills during recess, free from the constraints of adult direction. School administrators can reduce barriers to physical activity in this setting by utilizing a universal design approach. Simply, universal design focuses on accommodating the greatest number of individuals, in the widest possible range of situations, without the need for alterations. When applied to physical education, universal design supports the various ways that students receive, process and express information by proactively creating learning experiences that meet the needs of all students. Universal design strategies include three main components: (1) presenting information in multiple ways; (2) engaging students in a variety of instruction activities; and (3) using multiple means of assessment. These variations are embedded into lesson plans at the start and are not added in afterwards. Universal design is an evidence-based approach to providing inclusive physical activity in schools.

While universal design strategies close the gap in access and usability, there is still a need to adapt physical activity programming to meet the specific needs of some students. Physical education, which is a federally mandated service within special education, enables students with disabilities to develop a variety of physical, cognitive and social skills. However, within physical education the delivery of the curriculum and the type and training of professional delivering the content are inconsistent. Thus, students are challenged with developing such skills in an unpredictable manner. Adapted physical education consultation and service delivery allows skill acquisition delivered by a qualified professional. Adapted physical education involves a process in which one professional helps other experts, parents and community members to work more successfully with students with disabilities within the school setting. Increasing access to adapted physical education services can have a substantial impact on youth physical education. 

Call-to-action: Utilizing specialized services to support lifelong physical activity

Employing an ACSM/NCHPAD Certified Inclusive Fitness professional should also be considered to ensure developmentally appropriate physical activity programs and positive professional attitudes when interacting with children with disabilities outside of the school setting.

Professionals that may contribute to the physical activity needs of students with disabilities within the school setting include physical, occupational and recreational therapy. Physical therapy addresses issues of functional mobility use within the school environment and access to learning within a classroom or gymnasium/playground/field. The physical therapist also works on range of motion as it relates to a student’s ability to receive instruction, participate in activities and learn. Occupational therapy helps individuals restore and develop skills necessary for maximal independence and more specifically helps students with disabilities develop skills such as concentration, movement and problem-solving. Finally, recreational therapy specializes in the area of recreation and leisure activities, including art, aquatics, music, dance, drama, horticulture and outdoor recreation. Recreation therapists provide information about adaptations for recreation programs, information regarding leisure assessment and insights into available recreation/leisure programs in the community. Utilization of these specialized services can support students learning and motor skill development as well as enhance enjoyment of leisure activities, all of which may contribute to lifelong physical activity in students with disabilities. For school districts and communities where services are limited and/or unattainable, some things to consider are: collaboration and resource sharing with neighboring school districts; advocacy from both families and service professionals for these services to be included in children’s Individualized Education Program (IEP); and seeking out and receiving assistance from local and county human services to financially support and/or offset the cost of these services. 

Call to Action: Parent support and advocacy for inclusive physical activity opportunities

Parent support plays a vital role for promoting physical activity for children with disabilities both in and out of school. Factors such as encouragement, presenting opportunities for their children to engage in physical activity, enrolling their child in sport clubs at an early age and parental modeling all contribute to higher physical activity levels in this group. These experiences help children feel comfortable and open to participating in future physical activity opportunities both at school and in their community. Parents can also identify additional inclusive physical activity programs and resources provided by local universities, colleges and medical facilities. These programs have been instrumental in bridging the gap between rehabilitation and community-based health promotion. The National Center on Health, Physical Activity and Disability (NCHPAD) is a public health practice and resource center on health promotion for people with disability. NCHPAD’s website includes links to statewide resources for adapted physical activity opportunities. Programs highlighted in this directory can serve as models for inclusive physical activity in communities where opportunities are limited. More widely known programs for physical activity and sports for persons with intellectual disabilities (such as Down syndrome) include the Special Olympics and, for varied categories of disability, the Paralympics. Programs mentioned above also include online videos to promote physical activity in the home environment for individuals with disabilities. Examples include Special Olympics Fit 5,      NCHPAD’s Autism Exercise video series, and NCHPAD’s Home Workouts video series. Community programs that provide virtual opportunities for this population to engage in physical activity cannot be overemphasized, particularly in the current COVID-19 environment.

Finally, in Healthy People 2030 the U.S. Department of Health and Human Services emphasizes the need for daily participation of all students in physical activity. However, most elementary, middle and high schools allow “exemptions” to required student physical activity. Common reasons cited for “exemptions” are cognitive and physical disabilities. To promote inclusion and physical health, clinicians, families and educators need to advocate for all children, including those with disabilities, to participate in sports and recreational activities, to have access to adaptive equipment, proper training and clothing, adequate hydration and access to inclusive playgrounds, parks and recreational facilities.

The value of physical activity cannot be understated for children with disabilities as evidenced by the inclusion, for the first time, of physical activity recommendations for this group in The World Health Organization 2020 Guidelines on Physical Activity and Sedentary Behavior. By  restructuring physical opportunities at schools, working collaboratively with community supports and empowering parents to advocate for their children, we can realize the full potential of IDEA, and our children, irrespective of ability status.  

For additional information:

Lakowski, T. & Long, T. (2011). Proceedings: Physical Activity and Sport for People with Disabilities. Washington, DC: Georgetown University Center for Child and Human Development

Murphy N.A., Carbone P.S. (2008). American Academy of Pediatrics Council on Children With Disabilities. Promoting the participation of children with disabilities in sports, recreation, and physical activities. Pediatrics. May;121(5):1057-61.

King, G., Law, M., King, S., Rosenbaum, P., Kertoy, M.K., Young, N.L. (2003). A conceptual model of the factors affecting the recreation and leisure participation of children with disabilities. Phys Occup Ther Pediatr. 23(1):63-90.

Frost, J.L., Wortham, S.C., & Reifel, S. (2012). Play and child development. (4th ed.).Pearson.

Rimmer, J. H., & Rowland, J. L. (2008). Physical activity for youth with disabilities: a critical need in an underserved population. Dev Neurorehabil, 11(2), 141-148.

Inclusive Play Design Guide Workgroup (2015). Inclusive Play Design Guidehttps://www.accessibleplayground.net/wp-content/uploads/2016/05/Inclusive-Play-Design-Guide-LowRes-2.pdf

Authors: Marquell Johnson, Ph.D.; Vincenzo Nocera, Ph.D.; Navin Kaushal, Ph.D.; Lauren Simon, M.D., FACSM; Rebecca Hasson, Ph.D., FACSM, and the ACSM Strategic Health Initiative on Health Equity