Research and data
Limited data availability has a significant impact on the quality of research or policy development that can be done.
The limited data available on sport or physical activity participation for people with disability has a significant impact on the quality of research or policy development that can be done, especially for specific groups. 13, 30, 31, 32
- The United Nations ‘Convention on the Rights of Persons with Disabilities’ (2006) Article 31 states that parties (i.e. governments) undertake to collect appropriate information, including statistical and research data, to enable them to formulate and implement policies giving effect to the rights of people with disability. 30, 33
- In 2022, fourteen countries contributed to the first ‘Global Matrix of Para Report Cards on physical activity of children and adolescent with disabilities’. Even among those 14 motivated and engaged countries, only 11 (79%) could provide a grade for overall physical activity, and less than half (45%) of the Report Card indicators could be graded overall. 34
- Between 1999 and 2019, less than 5% of all articles published in the five highest-impact medical journals focused on people with disability, and less than 7% of these addressed physical activity or health. 30
When researching specific populations, it is important to remember the maxim of ‘nothing about us, without us’. Using partnership-based approaches to engage with the users who will benefit or apply the research throughout the process will help to produce findings that are relevant, useful, and useable. 30, 35
There is enormous scope to improve the quality of data and research by, for, and about persons with disability, and therefore the impact and scope of research, policy and program development that can be done to improve participation, health, and wellbeing outcomes for people of all abilities. 16, 31, 35
Resources and reading
- Making STEM More Inclusive of People with Disabilitie, opens in a new tabs, Sara Frueh, National Academies, (25 July 2023). As she grew up navigating life in a wheelchair, Anjali Forber-Pratt encountered obstacles both in the physical world and in other people’s mindsets. Forber-Pratt was among the speakers at a summit hosted by the National Academies — the first of a series of events in June that examined how ableism in STEM can keep people with disabilities from engaging and thriving in these fields, and explored how to advance STEM by creating more inclusive environments.
- Including Children and Youth with Disabilities in the 24-Hour Movement Guidelines, opens in a new tab, Veronica Allan, York University, SIRC, (3 December 2019). Engaging in regular physical activity, getting enough sleep, and limiting time spent inactive are well known and evidence-based prescriptions for the promotion of overall health and well-being. The Canadian 24-Hour Movement Guidelines for Children and Youth (ages 5-17) — which consolidate the evidence-based daily requirements for physical activity and inactivity, as well as sleep, into a single comprehensive resource — use the tagline Sweat, Step, Sleep, Sit and a logo in the shape of a “4” to represent a “new movement paradigm that emphasizes the integration of all movement behaviours occurring over a whole day” – moderate to vigorous physical activity (“sweat”), light physical activity (“step”), sleep, and sedentary behaviours (“sit”). But what about the kids and teens who cannot stand, step, or sweat? The Guidelines do not include any evidence-based recommendations for children and youth with a disability. To address this gap, a team of researchers from Queen’s University and the University of British Columbia set out to learn more about the potential inclusivity of the “sweat, step, sleep, sit” guidelines, and how the resource can be adapted for kids and teens of all abilities.
- Female athletes with ADHD: time to level the playing field, opens in a new tab, Collins K, British Journal of Sports Medicine, (30 April 2024). The significance of attention deficit hyperactivity disorder (ADHD) in athlete populations has received much attention over the last decade. ADHD is the most commonly diagnosed neurodevelopmental disorder, with a global prevalence of 5.9%–7.1% in adolescents and a male predominance ranging from 1.8 to 3.5:1. The prevalence may be even higher in athlete populations, at 7%–8%, with a similar sex ratio (7%–8% males vs 4% females).3 Certain ADHD traits that are well suited to the sporting context, such as quick movements, reactive decision-making, a tendency towards hyperfocus on enjoyable activities and a positive effect of physical activity on ADHD symptoms, may explain the apparent preponderance of ADHD in athletes. However, no studies have evaluated ADHD and how it specifically or directly affects the female athlete. ADHD can impact recovery from concussion, be influenced by hormonal fluctuations and affect mental health and social relationships, particularly in females. The purpose of this editorial is to raise awareness of the often-overlooked topic of ADHD in female athletes and encourage more investigation in this field.
- The Future of Para Report Cards on Physical Activity of Children and Adolescents With Disabilities—A Global Call for Engagement, Data, and Advocacy, opens in a new tab, Mark S. Tremblay, et al. Adapted Physical Activity Quarterly, Volume 41(1), pp.1-8, (2024). The Active Healthy Kids Global Alliance (AHKGA) is an international not-for-profit organization of researchers, health professionals, and stakeholders working together to advance the physical activity of children and adolescents around the world. The dominant effort of the AHKGA has been the Global Matrix initiative [which] involves the collaboration of multiple countries/jurisdictions working together to produce Report Cards on the physical activity of children and adolescents. Throughout the development of Global Matrices 1.0–4.0, there has always been an interest and intent to include children and adolescents with a disability (CAWD). However, the effort was rather passive and demonstrably ineffective. The Para Report Card initiative was a major contribution to the global knowledge of physical activity for CAWD, where 14 participating countries/jurisdictions followed harmonized but adapted procedures from the Global Matrix 4.0 to grade the same 10 physical activity indicators. This allowed useful international comparisons and also illustrated the scale of the global problems of both physical activity levels and physical activity surveillance in CAWD. Even among those 14 countries/jurisdictions with Para Report Cards, 45% of the Report Card indicators could not be graded as there was insufficient evidence, and 11/14 (79%) countries/jurisdictions were able to grade the key indicator of Overall Physical Activity for CAWD. The 2022 Global Matrix of Para Report Cards on Physical Activity of Children and Adolescents With Disabilities provided a substantial leap forward for raising awareness about gaps in research, services, opportunities, and policies for this underserved population.
- Global Matrix of Para Report Cards on Physical Activity of Children and Adolescents With Disabilities, opens in a new tab, Kwok Ng, Cindy Sit, Kelly Arbour-Nicitopoulos, et al., Adapted Physical Ability Quarterly, Volume 40(3), pp.409-430, (2023). This is an overview of the results from 14 countries or jurisdictions in a Global Matrix of Para Report Cards on physical activity (PA) of children and adolescents with disabilities. The methodology was based on the Active Healthy Kids Global Alliance’s Global Matrix 4.0. Data were aligned with 10 indicators (Overall PA, Organized Sport, Active Play, Active Transport, Physical Fitness, Sedentary Behavior, Family & Peers, Schools, Community & Environment, and Government) to produce Para Report Cards. Subsequently, there were 139 grades; 45% were incomplete, particularly for Active Play, Physical Fitness, and Family & Peers. Collectively, Overall PA was graded the lowest (F), with Schools and Government the highest (C). Disability-specific surveillance and research gaps in PA were apparent in 14 countries or jurisdictions around the world. More coverage of PA data in Para Report Cards is needed to serve as an advocacy tool to promote PA among children and adolescents with disabilities.
- Optimising health equity through para sport, opens in a new tab, Kristina Fagher, Stephanie DeLuca, Wayne Derman, et al., British Journal of Sports Medicine, Volume 57(3), pp.131-132, (2023). Nearly one in five of the world’s population lives with a disability. While physical activity, including sports participation, is important for all, people with disabilities are at inherent risk for low engagement with a consequential increased risk for chronic disease related to a sedentary lifestyle. Barriers to sports participation include poor knowledge of para sport (eg, which sports are available, how to find opportunities or train), lack of social support, poor accessibility to training facilities, lack of equipment and the devaluation of para sport across society4 (figure 1). An additional concern is the inequity in financial support for para sport, especially in low-resourced environments. Even in high-income countries, para sport is often underfunded in comparison to elite sport for athletes with no disability, and data have shown that Paralympic athletes do not have the same opportunities as Olympic athletes.5 This inequity begins early in life given that children with a disability are often excluded from physical education sessions or marginalised within the school sports system. To achieve this, more opportunities for people with disabilities are needed within healthcare, the education sector and sports organisations. Some potential solutions to promote health through para sport include: Prioritise research that focuses on athletes with disabilities; Educate healthcare professionals, physical education teachers, sports administrators and coaches about para sport, including how to train individuals with a disability; Inform policy-makers and advocates about the health benefits of para sport as well as ongoing barriers to participation that might be addressed through legislative solutions (eg, required inclusion of students with disabilities in school-based sports); Ensure that para athletes have the same financial support as athletes with no disability, providing equitable opportunities to participate in both recreational and competitive sport. Improving health equity for people with disabilities through physical activity and sport has the potential to enhance health among the 15% of people living with disabilities. This should be an urgent global health priority.
- “WOT” Do We Know and Do About Physical Activity of Children and Adolescents With Disabilities? A SWOT-Oriented Synthesis of Para Report Cards, opens in a new tab, Yeshayahu Hutzler, Sharon Barak, Salome Aubert, et al., Adapted Physical Activity Quarterly, Volume 40(3), pp.431-455, (2023). The purpose was to synthesize information gathered from the interpretation and conclusion sections of the Global Matrix of Para Report Cards on the physical activity of children and adolescents with disabilities. The synthesis was based on the strengths, weaknesses, opportunities, and threats framework. The procedure consisted of three stages: (a) the application of the International Classification of Functioning, Disability and Health as the theoretical framework; (b) identifying and aligning Global Matrix indicators and benchmarks with the International Classification of Functioning, Disability and Health components through a Delphi approach; and (c) using content analysis to identify themes from specific report cards. Outcomes reveal that further attention toward including children and adolescents with disabilities in fitness assessments is needed as well as adapted assessment methods. Program availability, equipment and facilities, and professional training emerged as strengths but need further development to overcome weaknesses. Paralympic inspiration was an opportunity, whereas extreme weather conditions presented potential threats to physical activity participation among children and adolescents with disabilities.
- Advancing sport opportunities for people with disabilities: from grassroots to elite, opens in a new tab, David Legg, Mary Dubon, Nick Webborn, et al., British Journal of Sports Medicine, Volume 56(22), pp.1266-1267 (2022). Sport, physical activity and recreation are important for everyone, but perhaps more so for the approximately 15% of the world’s population that experiences disability. The United Nations’ Convention on the Rights of Persons with Disabilities clearly states that the benefits of sport are relevant at every level of participation. This includes experiences from grassroots community-led clubs to school-based adaptive or inclusive sports opportunities, to high performance events including the Deaflympics, Special Olympics and Paralympic Games. The proportion of individuals experiencing disabilities who can and have benefitted from sport and recreation opportunities, however, continues to lag in comparison to the general population. The Sport and Exercise Medicine (SEM) community has an important role to play in ensuring that people with disabilities have opportunities to engage in physical activity and sport for health. Some ways in which SEM professionals can contribute to this global movement include:
- Include people with disabilities in your research or clinical team to ensure that the disability lived experience is recognised in all aspects of your work.
- If you are a researcher, ensure that your study design is inclusive of people with disabilities—this should include considerations for participant recruitment, outcome measure selection, data analysis and dissemination.
- If you are a clinician, learn about the unique medical conditions commonly impacting athletes with disabilities and how these may intersect with common sports-related injury and illness.
- Participation of people living with disabilities in physical activity: a global perspective, opens in a new tab, Kathleen Martin Ginis, Hidde P van der Ploeg, Charlie Foster, et al., The Lancet, Volume 398(10298), pp.443-455, (July 2021). Approximately 1·5 billion people worldwide live with a physical, mental, sensory, or intellectual disability, about 80% of which are in low-income and middle-income countries. This Series paper provides a global overview of the prevalence, benefits, and promotion policies for physical activity for people living with disabilities (PLWD). PLWD are 16–62% less likely to meet physical activity guidelines and are at higher risk of serious health problems related to inactivity than people without disabilities. Meta-analyses have shown that physical activity has beneficial effects on cardiovascular fitness (average standardised mean difference [SMD] 0·69 [95% CI 0·31–1·01]), musculoskeletal fitness (0·59 [0·31–0·87]), cardiometabolic risk factors (0·39 [0·04–0·75]), and brain and mental health outcomes (0·47 [0·21–0·73]). These meta-analyses also show that health benefits can be achieved even with less than 150 min of physical activity per week, and suggest that some physical activity is better than none. Meta-analyses of interventions to increase physical activity for PLWD have reported effect sizes ranging from SMD 0·29 (95% CI 0·17–0·41, k=10) to 1·00 (0·46–1·53, k=10). There is increasing awareness among policy makers of the needs of PLWD for full participation in physical activity. Physical activity action plans worldwide must be adequately resourced, monitored, and enforced to truly advance the fundamental rights of PLWD to fully participate in physical activity.
- A global perspective on disparity of gender and disability for deaf female athletes, opens in a new tab, Becky Clark, Johanna Mesch, Sport in Society , Volume 21(1), pp.64-75, (2018). Although the significance of gender and disability issues has gradually increased in the global society during the past three decades, there are only few studies with regard to the deaf community and sport. This article examines the level of Deaf or Hard-of-Hearing women’s participation in sports and the factors for their continued underrepresentation. The Women Sport International’s Task Force on Deaf and Hard of Hearing Girls and Women in Sport conducted a world-wide survey to determine and assess the needs of deaf and hard of hearing girls and women in sport. A snapshot of the results and issues and future aspirations are provided.
- SPARTAN Sports and recreation for people with disabilities, opens in a new tab, University of Sydney/FMH Networks, YouTube, (13 March 2024). A series of short talks and a panel discussion about sport and physical recreation for people with disabilities.
- Presentation 1 - Sport and Recreation for People with Disability, Craig Carscadden PLY, World Abilitysport.
- Presentation 2 - The effects of sport and physical recreation for adults with physical or intellectual disabilities: a review of the evidence, Leanne Hassett, A/Profesor, School of Health Sciences, University of Sydney.
- Presentation 3 - Development of Physical Disability Rules in Rugby League - from Inception to NRL Affiliation: "Triumphs and Tears", Dr Che Fornusek, EXSS, School of Health.
- Presentation 4 - Talking about research projects 'Sport for Children with Disabilities: Evidence and Systems' and 'A Systems Thinking Approach to the Inclusion of Children with Disabilities in Little Athletics in Australia', Kerry West PhD student, Institute for Musculoskeletal Health
- Panel Discussion - Dr Phil Hamdorf, Heather Berry, and Rae Anderson PLY in addition to speakers, Criag Carscadden, Leanne Hassett, Kerry West.
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