. The studies were identified by two independent researchers following predetermined inclusion and exclusion criteria. The methodological quality was determined using the McMaster University critical review forms for qualitative or quantitative research and was numerically rated according to the criteria developed by Imms. RESULTSThe initial electronic search yielded 10 161 articles, of which six were qualitative and 12 were quantitative studies. These studies showed that a diverse range of positive and negative factors were associated with participation in physical activity, such as self-efficacy, physical fitness, increasing age, and the availability of equipment and local facilities.INTERPRETATION Future intervention studies could use these results, within the context of an individual child and his or her environment, as the basis for increasing physical activity levels, starting in early childhood and continuing throughout adolescence and into adulthood. An increased awareness of and focus on providing appropriate equipment and adapted sports in the child's own environment by policy makers might increase physical activity levels.A recent Lancet series 1 reported on the importance of being physically active in reducing the development and mortality of non-communicable diseases such as cancer, type II diabetes, and cardiovascular disease.2 For children in particular, the benefits of physical activity have been consistently documented and it is recognized that encouraging a physically active lifestyle from an early age is important. 3Physical activity can increase the physical, emotional, and social well-being of children with physical disabilities, as well as increasing their functional independence, integration, and quality of life and positively impacting their future health.4-6 Therefore, it is alarming to see a decline in the physical activity of young people. 7 Children with physical disabilities are even less physically active than their peers with typical development.8-11 A systematic review recently showed that young people with cerebral palsy (CP) participated in habitual physical activity at a rate that was 13% to 53% lower than in those with typical development and 30% lower than the recommended guidelines.12 A group of 85 Dutch children with several physical disabilities had significantly lower physical activity, with a prevalence of overweight and obesity three and six times higher respectively, than children with typical development. 13 Moreover, a large group of children with disabilities participating in a Fitkids exercise therapy programme showed both reduced aerobic fitness and a high prevalence of overweight and obesity before the programme. 14 Another systematic review identified a range of personal, social, environmental, and policy-and programme-related factors that influence physical activity in children and adolescents with disabilities. 15 The available literature includes several types of disabilities, including both intellectual and behavioural disabilities, which makes it difficult ...
BackgroundYouth with spina bifida (SB) are less fit and active than other groups with childhood disability. While recent studies have shown benefits of exercise training, the increased fitness levels do not sustain or lead to increased levels of physical activity (PA) in these children. Therefore, it seems important to explore which factors are associated with participation in PA (or lack of) in youth with SB. The objective of this study is to describe both personal and environmental factors that are important for participation in physical activity as experienced by these children and their parents, in order to better develop intervention strategies to improve participation in PA in youth with SB.MethodsEleven semi-structured interviews with parents of children with SB aged 4–7 years, nine focus groups with youth with SB (n = 33, age 8–18 years) and eight focus groups with their parents (n = 31) were conducted, recorded and transcribed verbatim. Two independent researchers analyzed the data. Central themes for physical activity were constructed, using the model for Physical Activity for Persons with a Disability (PAD model) as a background scheme.ResultsData showed that youth with SB encountered both personal and environmental factors associated with participation in PA on all levels of the PAD model. Bowel and bladder care, competence in skills, sufficient fitness, medical events and self-efficacy were important personal factors. Environmental factors that were associated with physical activity included the contact with and support from other people, the use of assistive devices for mobility and care, adequate information regarding possibilities for adapted sports and accessibility of playgrounds and sports facilities.ConclusionsOur findings suggest that a variety of both personal and environmental factors were either positively or negatively associated with participation in PA. An individual approach, assessing possibilities rather than overcoming barriers within and surrounding the child may be a good starting point when setting up intervention programs to improve participation in PA. Therefore, assessment of both personal and environmental factors associated with physical activity should be standard care within multidisciplinary intervention programs aimed to encourage healthy active lifestyles in youth with SB.
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