Participation in physical activities and sedentary behaviour among children with physical disabilities

Participating in physical activity promotes physical and mental health. Children with physical disabilities are not as physically active as
other children. They tend to participate in lower intensity physical activity, choose more passive activities with less variety and have
more sedentary time. The overall aim of this thesis was to gain knowledge about participation in physical activities, to identify
associated factors for school and leisure time and to explore the perceived experiences of the children and the parents about possible
facilitators or barriers associated with physical activities. A further aim was to evaluate the feasibility of Physical Activity Referrals (PAR)
and outcome measures for children with physical disabilities and its effectiveness on increasing participation in physical activity and
decreasing sedentary behaviour. The thesis is comprised of three studies with children with various gross- and fine motor,
communicative and cognitive functions. In Study I (Paper I) a total population of 364 children and adolescents with cerebral palsy (CP)
aged 7-17 years was studied by using cross-sectional data from the National Quality Registry CP follow-up programme (CPUP). In
Study II qualitative interviews with 16 children with CP, aged 8-11 years (Paper II), and with 25 of their parents (Paper III) were
performed and analysed by content analysis. In Study III (Paper IV), 14 children with physical disabilities, aged 7-12 years, participated
in PAR together with 24 of their parents. The intervention was based on a written agreement of self-selected physical activities,
motivational interviewing (MI), goal-directed outcome measurements Canadian Occupational Performance measure (COPM) and Goal
Attainment Scaling (GAS) and assessments including Gross Motor Function Measure (GMFM-66), physical activity monitors, the
International Physical Activity Questionnaire (IPAQ) and other questionnaires at baseline, and after 8 and 11 months. Children and
adolescents with more severe motor limitations, with intellectual disability and with thinness seem to have the greatest needs for
interventions to increase their participation in physical activities and reduce sedentary behaviour. Children discussed that they want to
be asked about their wishes and needs, and get the opportunity to try self-selected physical activities with individualised support, as well
as to have fun with family and friends, have someone to do the activity with and enjoy the sensation of speed. Environmental factors
could be either facilitators or barriers, while pain, fatigue and the perception of not being good enough were considered barriers. The
parents experienced several challenges when their child wanted to be physically active: parents wanted to protect their child while also
pushing them towards independence. They wanted competent persons to be available to assist their child in participating in the physical
activities and support them in finding friends to be active with. Family culture and attitudes affect children’s motivation for being
physically active and should be taken into account. In Study III the families were compliant and there were no dropouts; there were
positive evaluations of PAR. The families learned more about the accessibility and locations of physical activities, and the children got
the opportunity to try their self-selected activities with individualised support. Several children made new friends through engaging in
self-selected group activities. In addition, most children were able to maintain the physical activity levels; the outcome scores for
GMFM-66, COPM and GAS were maintained for some and increased for most children. Modifications by synchronising physical
activity measures into the same time periods and to give a feedback to the families close in time to the baseline measures are
recommended. In this thesis the children with the greatest needs of a more active lifestyle have been identified, and we have listened to
their voices and talked with them and their parents before designing an individualised intervention. Families with different ethnical,
cultural and socioeconomic backgrounds participated in the studies. PAR promotes an active lifestyle by increasing participation,
motivation and engagement in physical activities and social participation. The intervention involves both everyday and organised
habitual physical activities. To our knowledge, this is the first study about PAR in children with disabilities that measures objective and
estimated physical activity. The results suggest that PAR is feasible and effective for children with physical disabilities.