Question & problem
Many people with disabilities are not able to engage in the recommended amount of physical activity needed to get the maximum health benefits from exercise. People with disabilities are less likely to be physically active than people without disabilities, partly due to inaccessible environments and partly because of limitations in functioning associated with some impairments. This evidence brief explores how to improve access to and engagement in physical activity among people with disabilities. It makes evidence-based recommendations about how barriers to physical activity for people with disabilities residing in low- and middle-income countries (LMICs) can be overcome. We note that this area should be considered in an impairment-specific way, but because the existing evidence is so limited, it is not currently possible to create different briefs on this topic. More research and synthesis is required in this area, to ensure that recommendations are tailored appropriately to impairment type and age group.
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Recommendations
Key recommendation
Action
Improve disability-specific knowledge through healthcare training programs to better equip healthcare providers to increase awareness, offer support and create more inclusive environments for people with disabilities. Train healthcare providers, including primary healthcare workers and rehabilitation specialists, to discuss the importance of physical activity with people with disabilities and link them to available programmes or low-cost exercise options.
Key recommendation
Action
Train fitness and recreation staff, education sporting coaches, programme coordinators, and physical educators to support people with disabilities during physical activity. Include training on how to use adapted equipment and how to adapt exercises. Involve people with disabilities in training programmes to improve the competence and confidence of fitness professionals.
Key recommendation
Action
Provide information on home-based, free physical activity alternatives, and promote available physical activity programmes in different communities. Physical activity campaigns should encourage persons of all abilities to be physically active. Integrated physical activity should be encouraged over segregated programmes, so as to improve social inclusion for people with disabilities, and awareness-raising should also be aimed at those without disabilities. Ensure the repackaging of research findings, such as this evidence brief, into easily accessible formats relevant to the public.
Key recommendation
Action
Encourage collaboration between the medical, fitness, and community sectors to identify barriers and facilitators to physical activity participation for people with disabilities to promote long-term engagement. Create opportunities for collaboration with people with lived experience (i.e. people with disabilities) to determine what works for this population and facilitate sharing of skills and best practices.
Key recommendation
Action
Implement research- and evidence-based sustainable interventions in communities. Increase funding and support of quality community-based physical activity and exercise programmes that are inclusive and adaptable for people with disabilities. Provide accessible infrastructure in communities to facilitate physical activity.
Challenges
Challenge #1: Environmental infrastructure in LMICs is not conducive to promoting physical activity for people with disabilities
- Exercise facilities are often inaccessible, lack adaptive equipment, and may not have supports to enable individuals with carers or personal support needs to participate.
- Participating in outdoor physical activity is a challenge for people with physical and sensory disabilities because sidewalks in low-resourced settings are often damaged, lack appropriate curb cuts, and are an inappropriate width for use by people using wheelchairs or crutches, or individuals with vision impairments. Crime and safety issues can also create a barrier to participation in outdoor physical activity, particularly in LMICs.
- Accessible transport to and from exercise programs and facilities is hard to come by. Additionally, people with disabilities may require assistance from caregivers to use public transport, which is often unreliable and inaccessible in LMICs.
Challenge #2: The additional costs associated with participating in physical activity can be prohibitive for people with disabilities
- People with disabilities are likely to be more economically vulnerable than people without disabilities, leading to a deprioritisation of activites other than those related to meeting basic needs.
- Inadequate financial resources in LMICs limit the availability of physical activity programs that cater to people with disabilities.
- Although options for cost-free physical activity may be available, they are scarce and may not be disability-inclusive.
- The extra costs associated with accessible transport are additional barriers for people with disabilities, making it difficult for them to travel to sports grounds, gyms, and public pools as these are often concentrated in better-resourced urban areas.
Challenge #3: Stigma and insufficient social support prevent people with disabilities from participating in physical activity
- Stigmatising behaviour from the general public, such as negative comments, discrimination, and a lack of disability awareness, can discourage people with disabilities from engaging in physical activities in shared spaces.
- People with physical disabilities may require help from caregivers or facilitators to use adapted equipment or undertake physical activity but in LMICs, there is a lack of human support services. Where such support is available, other activities (like daily tasks) are generally prioritised over exercise.
Challenge #4: Health professionals and fitness staff lack appropriate training in maintaining physical activity for people with disabilities
- There is a lack of training on physical activity and disability in the healthcare sector. The importance of physical activity is not discussed or adequately communicated with people with disabilities.
- In addition, staff at fitness facilities often lack the skills needed to adapt activities and create inclusive environments, preventing people with disabilities from utilising these opportunities for physical activity.
Challenge #5: Lack of appropriate resources, information, and opportunities regarding where and how to exercise
- Research on exercise for people with disabilities is not generally converted into resources that are easily understood by the wider public. Opportunities for physical activity are not well advertised or targeted toward people with disabilities, and there is little emphasis on policy-making in this areas.
- Different impairment types will require different approaches. For example, people with intellectual disabilities may require additional support to discover the opportunities or resources that do exist.
Finding the answers
This review of reviews examined systematic, scoping, and rapid reviews of the evidence on improving engagement in and access to physical activity for people with disabilities. Literature reviews from LMICs and high-income countries (HICs) form the basis for the recommendations presented. Recommendations made specifically for HICs were examined for transferability to low-resource settings. This evidence brief is based on the findings of seven reviews of both LMICs and HICs, and nine reviews exclusively from HICs.
Recommendations & actions
Key recommendation
Action
Improve disability-specific knowledge through healthcare training programs to better equip healthcare providers to increase awareness, offer support and create more inclusive environments for people with disabilities. Train healthcare providers, including primary healthcare workers and rehabilitation specialists, to discuss the importance of physical activity with people with disabilities and link them to available programmes or low-cost exercise options.
Key recommendation
Action
Train fitness and recreation staff, education sporting coaches, programme coordinators, and physical educators to support people with disabilities during physical activity. Include training on how to use adapted equipment and how to adapt exercises. Involve people with disabilities in training programmes to improve the competence and confidence of fitness professionals.
Key recommendation
Action
Provide information on home-based, free physical activity alternatives, and promote available physical activity programmes in different communities. Physical activity campaigns should encourage persons of all abilities to be physically active. Integrated physical activity should be encouraged over segregated programmes, so as to improve social inclusion for people with disabilities, and awareness-raising should also be aimed at those without disabilities. Ensure the repackaging of research findings, such as this evidence brief, into easily accessible formats relevant to the public.
Key recommendation
Action
Encourage collaboration between the medical, fitness, and community sectors to identify barriers and facilitators to physical activity participation for people with disabilities to promote long-term engagement. Create opportunities for collaboration with people with lived experience (i.e. people with disabilities) to determine what works for this population and facilitate sharing of skills and best practices.
Key recommendation
Action
Implement research- and evidence-based sustainable interventions in communities. Increase funding and support of quality community-based physical activity and exercise programmes that are inclusive and adaptable for people with disabilities. Provide accessible infrastructure in communities to facilitate physical activity.
Policy priorities
Governments and other stakeholders should prioritise funding for programmes and initiatives which reduce barriers to physical activity for people with disabilities. Provisions could include mandatory training of healthcare providers, improved accessibility of infrastructure, provision of appropriate and adaptable fitness equipment, and the development of inclusive community-based physical activity programs. Policymakers must prioritise collaboration with people with lived experience of different disabilities and community organisations to inform decision-making.
Conclusion
People with disabilities face multiple barriers to attaining a physically active life. In HICs, there is evidence of the benefits of training of healthcare and fitness professionals, information provision, and promotion of disability awareness for engagement in physical activity. More evidence from LMICs is urgently needed. Policymakers should engage people with disabilities in decision-making regarding physical activity promotion.
Gaps & research needs
There is a need for more research in LMICs, where people with disabilities face different barriers to physical activity. Future research should focus on physical activity for all people with disabilities, particularly wheelchair users, as this group is under-represented in the literature. Additional research and synthesis is also required to consider this question in an impairment-specific way.
Acknowledgements
Peer review: This evidence brief was peer reviewed by Dr Clare Harvey, Senior Lecturer at the Psychology Department at the University of the Witwatersrand, South Africa, and Dr Phoebe Runciman, Lecturer at the Institute of Sport and Exercise Medicine (ISEM) at Stellenbosch University, South Africa.
Publication details: © Stellenbosch University, June 2023.
Suggested citation: Kelsey Andrews and Xanthe Hunt. Evidence Brief: How can engagement and access to physical activity be improved for people with disabilities? Disability Evidence Portal, 2023.
Disclaimer: The views expressed in this publication are those of the author/s and should not be attributed to Disability Evidence Portal and/or its funders.