Physical Activity
Keri Vanderbom, Chair
Amy McPherson
David Kanter
Lynne Logan
John Foley
Outcomes
• Primary: Increase (or maintain) the amount of daily physical activity
participated in at the different age levels.
• Secondary: Increase knowledge and awareness of physical activity (i.e.,
benefits, safety, what/how to do it)
• Tertiary: Improve health outcomes through physical activity participation
across the lifespan (holistically- maintenance of function, prevent secondary
conditions, mental health)
Prenatal/Infancy (through age 1 year)
Clinical Questions
1. Is there evidence that the early motor skill intervention increases physical
activity across the lifespan?
2. How early should doctors and therapists talk to parents/caregivers about
physical activity for infants/children with SB?
3. Are physical activity goals included the Individual Family Service Plan (ages 03) (beyond physical and occupational therapy)?
Prenatal/Infancy (through age 1 year)
Guidelines
1. Conduct infant motor skills assessment to evaluate motor dysfunction in infants
with SB to determine the best intervention to improve motor outcomes.1
2. Provide guidance to parents, and include physical therapists, about how to
encourage movement and activity in their infant.2
3. Inform parents of their child’s rights to early intervention services that include
adapted physical education/activity and encourage parents to advocate for
physical activity goals to be added to the IFSP plan.3
Toddler (1-3 years)
Clinical Questions
1. What strategies work to educate parents about physical activity importance
and ways to get their child involved?
2. How early should parent education about physical activity start? What
resources are available?
3. What is the most successful way to encourage parents to invest (time and
money) in physical activities for their young children with SB?
Toddler (1-3 years)
Guidelines
1. Discuss with parents the importance of involving toddlers with SB in formal
and informal recreation, physical activity, and social programs/services where
they can be actively engaged with their disabled and non-disabled peers.
2. Discuss with parents the physical and mental health benefits of physical.
3. Discuss the importance of parental modeling physical activity as part of a
healthy lifestyle.
4. Provide parents with information and/or resources about adapted and inclusive
activities for their child.
Toddler (1-3 years)
5. Use motivational interviewing techniques to talk about physical activity goals
and work through barriers.4
6. Inform parents of their child’s rights to adapted physical education/activity and
encourage parents to advocate for physical activity goals to be added to their
Individualized Family Service Plan.3
Preschool (3-5 years)
Clinical Questions
1. Given that many of these children will be limited in their physical function,
when and what activities should they be exposed to (e.g., typical kids start
playing baseball, soccer and other team sports at age 4-5)?
2. Should kids with SB start similar activities at the same age?
3. What training will coaches need to welcome our kids to meaningful play?
4. How does proper/improper mobility equipment affect the youth’s ability to
participate in physical activity (e.g., a wheelchair that fits properly, proper
seating and back set up, AFO’s, crutches, etc.)?
Preschool (3-5 years)
Clinical Questions
5. Related to physical activity/exercises that help maintain function- upper and
lower body- Who can parents and doctors consult (e.g., PT, OT, Recreation
Therapists, fitness staff, NCHPAD)?
Preschool (3-5 years)
Guidelines
1. Discuss with parents the importance of involving children with SB in formal and
informal recreation, physical activity, limiting sedentary behaviors and social
programs/services where they can be actively engaged with their disabled and
non-disabled peers.5
2. Discuss strategies that balance the parent’s involvement with their child’s need
for independence to participate in physical activity.6
3. Discuss life-long benefits of physical activity e.g. active adults with SB report
more functional independence and a higher quality of life compared to those
with SB who are inactive.7
4. Use a team approach and include PT/OT’s to work with parents to ensure kids
have proper fitting mobility equipment to maximize physical activity
participation.
Preschool (3-5 years)
Guidelines
5. Educate parents of their child’s rights to adapted physical education/activity in
preschool and encourage parents to advocate for physical activity goals to be
added to their Individualized Family Service Plan.3,8
School Age
Clinical Questions
1. What are life-long activities that do not predispose to shoulder injury or skin
injury? How young can these realistically be started (e.g., snow skiing,
riding, power soccer, sled hockey)?
2. What are some strategies to continue physical activity (or physical
education) when in the hospital or after a long hospital stay (e.g.,
Theraband stretches, increasing knowledge of physical activityreading/lecture style- if no PA/movement is allowed)?
3. Is there evidence about the benefits/effects on physical activity levels of
youth with SB advocating for themselves on their physical education goals
in their Individualized Education Program meetings?
School Age
Clinical Questions
4. Does the evidence support adapted physical education vs. Inclusive
physical education? Is this support related to health or socialization,
something else, or all three?
5. What training do schools need to include children with SB in meaningful
play throughout the day (at recess, physical education class, on-site
afterschool programs)?
6. What are some ways that physical education teachers can be more
inclusive of children with SB? How do we start this process as early as
possible?
School Age
Clinical Questions
7. In school age and older age groups, address how sports can improve selfesteem. The vast majority of people in adapted sports programs are people
with adult onset conditions so it is important to know how involving kids with
SB at early ages could improve self-esteem (as opposed to getting them
involved later as teens).
8. Are kids more likely than adults to join adapted sports programs? Does
getting a child engaged in sports at a young age improve the likelihood that
they will remain engaged in activity throughout their lifespan?
School Age
Guidelines
1. Discuss with parents the importance of involving children with SB in formal
and informal recreation, physical activity, limiting sedentary behaviors and
social programs/services where they can be actively engaged with their
disabled and non-disabled peers.5
2. Advocate for the participation of all children, including those with SB, in
sports and physical activity programs.9
3. Inform parents of their child’s rights to adapted physical education/activity
and encourage parents to advocate for physical activity goals to be added
to their child’s Individualized Education Plan.
School Age
Guidelines
4. Encourage parents to consider the environment in which their child feels
most comfortable being physically active- some children feel more
comfortable with other children who have similar abilities. Others want to be
included in activities alongside people with all abilities.10
5. Support parents to develop an action plan of behavioral strategies to
support their child’s physical activity.11
a. Develop a local/regional therapeutic recreation and adapted sport
resource guide.17
b. Identify and provide addition support to parents for youth with shunts
and lower motor function.17
c. Discuss strategies that balance the parent’s involvement with their
child’s need for independence to participate in physical activity.6
Teenage
Clinical Questions
1. Do adapted physical education programs in schools adequately prepare (via
transition plan) students with spina bifida to lead physically active lifestyles?
2. What are the physical activity contraindications for teens with SB?
3. What are the types of physical activity used or recommended in the literature
specific to teens with SB (resistance, cardio, incidental activity vs. planned
physical activity/exercise)?
Teenage
Clinical Questions
4. What is the best setting for physical activity for teens (e.g., in a group, at home,
etc.) where they are most comfortable and likely to continue participation?
5. What are the doses of physical activity used or recommended in the literature
for teens with SB? Are they effective for health changes?
6. Is physical activity included in the teen’s Individualize Transition Plan (the plan
post high school graduation)?
Teenage
Guidelines
1. Discuss with teens with SB the importance of reducing sedentary behaviors
and being involved in physical activity where they can be actively engaged
with their disabled and non-disabled peers.5
2. Prescribe physical activity for youth with SB.12
3. Educate the teen and parents of their right to adapted physical
education/activity and encourage the teen and parent to advocate for
physical activity goals to be added to their teen’s Individualized Education
Plan.
Teenage
Guidelines
4. Explore the settings where teens with SB feel most comfortable being
physically active- some teens feel more comfortable with other
children who have similar abilities. Others may want to be included in
activities alongside people with all abilities. 10
a. Use motivational interviewing techniques to talk about physical
activity goals and work through barriers.4
b. Provide a local/regional therapeutic recreation and adapted sport
resource guide to teens.
5. Highlight that adolescence is a critical period for building physical
activity into the daily routines of persons with SB in an effort to
preserve overall lifelong satisfaction and community participation.13
Guidelines For All Children and Teens
1. There are no national guidelines specific to the amount of physical
activity that children and teens with SB should participate in, however,
there are national guidelines for the general population of
children/teens (ages 6-17 y/o).14 These guidelines should be followed
as close as possible for children/teens with SB unless medically
unsafe as advised by a doctor:
• 60 minutes of physical activity or more each day14:
• Aerobic activity should make up most of the youth’s activity each day;
vigorous intensity aerobic activity should be done at least 3
days/week
• Muscle strengthening activities should be done at least 3 days/week
as part of the 60 or more minutes
• Bone strengthening activities should be done at least 3 days/week as
part of the 60 or more minutes
Guidelines For All Children and Teens
2. Include a discussion on physical activity at yearly doctor’s
appointments and follow up in subsequent years to check on
goals met.
3. Understand the benefits of the participation of youth with
disabilities in sports and physical activities. 9, 15
4. Perform pre-participation evaluations for youth with disabilities in
collaboration with the youth and family, pediatric specialists,
therapists, coaches, and others to identify medical risks
participating and modifications that can be made to ensure
participation. 9
a. Identify strategies to minimize risks of illness and injury related to
participation through activity adaptations and safety precautions. 9
Guidelines For All Children and Teens
5. Recognize and reduce child, family, and societal barriers to the
participation of youth with disabilities in physical activity and
sports. 9
a. Work with the youth with SB and their family to address personal
barriers such as bowel/bladder care, medical events, assistive devices,
as well as environmental factors.16
Adult
Clinical Questions
1. What are the physical activity contraindications for adults with SB?
2. What are the types of physical activity used or recommended in the
literature specific to adults with SB (resistance, cardio, incidental activity vs.
planned physical activity/exercise)?
3. What is the best setting for physical activity for adults (e.g., in a group, at
home, etc.) where they are most comfortable and likely to continue
participation?
4. What are the doses of physical activity used or recommended in the
literature for adults with SB? Are they effective for health changes?
Adult
Guidelines
1. Include a discussion on physical activity at yearly doctor’s appointments
and follow up in subsequent years to check on progress made towards
goals.
2. Discuss the importance of physical activity and physical activity options with
adults with SB7 and use motivational interviewing techniques to talk about
physical activity goals and work through barriers.4
a. Emphasize that any movement is beneficial.14
3. Prescribe physical activity to adults with SB.12
Adult
Guidelines
4. There are no national guidelines specific to the amount of physical activity that
adults with SB should participate in, however, there are national guidelines for
the general population of adults.14 These guidelines should be followed as
close as possible for adults with SB unless medically unsafe as advised by a
doctor.
a. All adults should avoid inactivity. Some physical activity is better than none,
and adults who participate in any amount of physical activity gain some
health benefits. 14
Adult
Guidelines
b. For substantial health benefits, adults should do at least 150 minutes (2
hours and 30 minutes) a week of moderate-intensity, or 75 minutes (1
hour and 15 minutes) a week of vigorous-intensity aerobic physical
activity, or an equivalent combination of moderate- and vigorousintensity aerobic activity. Aerobic activity should be performed in
episodes of at least 10 minutes, and preferably, it should be spread
throughout the week. 14
Adult
Guidelines
c. For additional and more extensive health benefits, adults should
increase their aerobic physical activity to 300 minutes (5 hours) a week
of moderate-intensity, or 150 minutes a week of vigorous-intensity
aerobic physical activity, or an equivalent combination of moderate- and
vigorous-intensity activity. Additional health benefits are gained by
engaging in physical activity beyond this amount. 14
d. Adults should also include muscle-strengthening activities that involve all
major muscle groups on 2 or more days a week.14
Research Gaps
1. What are the barriers and facilitators to meeting the required weekly
moderate to vigorous physical activity at different ages across the lifespan?
2. What are the different physical activity strategies needed for individuals with
SB living in rural areas v. cities at different ages?
3. What are the social/environmental strategies/solutions (e.g., need for
accessible facilities, knowledgeable staff, etc.) needed to get individuals
with SB physically active?
4. What are the strategies/solutions needed to intrinsically motivate individuals
with SB to be physically active (e.g., peer support, increased knowledge,
self-efficacy, etc.)?
5. What are the consequences of sedentary behavior specific to individuals
with SB and how early are the consequences of sedentary behavior
evident?
Research Gaps
6. How can we best educate and train parents and individuals with SB
to be advocates for their inclusion in physical activity in their
communities at large?
7. What physical activity resources are available for doctors nationwide,
locally? What resources need to be created?
8. What physical activity and/or exercises can help maintain functionupper and lower body during the different age groups?
9. Is there (or what is the strength of) evidence that physical activity
prevents secondary conditions?
10. What is considered excessive physical activity/exercises that may
cause injuries?
11. What are the social/health benefits of participating in physical activity
for individuals with SB at different ages?
Research Gaps
12. What resources or programs are available to increase physical activity at
different life stages?
13. Are there any treatments to increase physical activity in PT or OT that are
being developed or researched?
14. Which types of exercise are best for certain age groups? For example, if an
adult has not tried any exercises, are there recommendations for where to
start out? Or, are the recommendations the same as for the general
population?
References
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2.
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in families of adolescents with physical disabilities. Child: care, health and development, 34(2), 185-193. doi:10.1111/j.13652214.2007.00782.x
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