Cardiovascular risk profiles clusters among children and adolescents with disabilities.

BACKGROUND: Cardiovascular diseases (CVD) are a precursor for disabilities and death worldwide. Being overweight or obese in combination with physical inactivity and smoking habits may increase the risk for CVD and other health problems such as lower limb osteoarthritis, diabetes, stroke, and various cancer types among children and adolescents. The literature emphasizes the need to follow such groups and evaluate the risk of individuals developing CVD diseases. Therefore, the current study explores the variety of cardiovascular risks in children and adolescents' profiles clusters with and without disabilities. METHODS: Data from 42 countries including Israel, was collected with the support of the world health organization (WHO, Europe) through a questionnaire from 11-19 years old school-aged. RESULTS: The study finding shows that children and adolescents with disabilities demonstrated a higher prevalence of overweight than those who completed the HBSC youth behavior survey. Moreover, the prevalence of tobacco smoking and alcohol use was statisticaly significantly higher among the disabled group than the non-disabled group. In addition, socioeconomic status of responders who presented a very high CVD risk was found as significantly lower than those from the first and second low risk groups. CONCLUSION: This led to the conclusion that children and adolescents with disability were at a higher risk of developing CVDs than their non-disabled peers. In addition, intervention programs tailored to the needs of adolescents with disability should consider lifestyle habit change and promoting healthy living thus improving their quality of life as well as reducing their risk of being exposed to severe CVD diseases.

2022 Para Report Card on Physical Activity of Israeli Children and Adolescents With Disabilities.

Children and adolescents with disabilities (CAWD) represent 11% of Israeli children and adolescents. The 10 core indicators of the Global Matrix on Para Report Cards of physical activity (PA) of CAWD were used to create the 2022 Israeli Para Report Card. A panel of four experts reviewed resources and synthesized evidence of PA behaviors and policies for CAWD in Israel, converted the data to grades, and charted subcategories of language, sex, and disability across population. Data sources were surveys, reports, and memberships in sport federations and clubs. Among CAWD, levels of participation in daily PA were poor (<20%; Grade F), and participation of CAWD in sports was even lower (<10%; Grade F). A lack of environmental infrastructure may explain the low levels of participation. Females, Arabic speakers, and physiological CAWD need particular attention. Establishing governmental policies and interventions is required to increase overall PA and participation in sports among CAWD.

Reverse Integration in Wheelchair Basketball-A Mixed-Method Spanish Stakeholders' Perspective.

In Spain, wheelchair basketball competition is well developed and structured; however, reverse integration is not allowed. This study aimed to describe and synthesize the perceptions of Spanish wheelchair stakeholders (players, coaches, referees, and club managers). A mixed-method approach was used, utilizing an ad hoc survey questionnaire (n = 49) and three focus groups (n = 12). Quantitative and qualitative data were interpreted using a triangulation strategy, meaning that both sources of data were combined and analyzed. From the thematic content analysis, two main themes and several subthemes emerged: social context (audience attraction and economic impact, utility and logistics, and promoting inclusion) and sport context (grassroots and elite level). Some reservations at elite level were also reported. From the perspective of the stakeholders explored in this study, reverse integration appears to be well suited for implementation within the Spanish wheelchair basketball framework at all levels.

"WOT" Do We Know and Do About Physical Activity of Children and Adolescents With Disabilities? A SWOT-Oriented Synthesis of Para Report Cards.

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.

Global Matrix of Para Report Cards on Physical Activity of Children and Adolescents With Disabilities.

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.

Comparison of Habitual Physical Activity and Sedentary Behavior in Adolescents and Young Adults With and Without Cerebral Palsy.

PURPOSE: The comparison of habitual physical activity and sedentary time in teenagers and young adults with cerebral palsy (CP) with typically developed (TD) peers can serve to quantify activity shortcomings. METHODS: Patterns of sedentary, upright, standing, and walking components of habitual physical activity were compared in age-matched (16.8 y) groups of 54 youths with bilateral spastic CP (38 who walk with limitations and 16 who require mobility devices) and 41 TD youths in the Middle East. Activity and sedentary behavior were measured over 96 hours by activPAL3 physical activity monitors. RESULTS: Participants with CP spent more time sedentary (8%) and sitting (37%) and less time standing (20%) and walking (40%) than TD (all Ps < .01). These trends were enhanced in the participants with CP requiring mobility devices. Shorter sedentary events (those <60-min duration) were similar for TD and CP groups, but CP had significantly more long sedentary events (>2 h) and significantly fewer upright events (taking <30, 30-60, and >60 min) and less total upright time than TD. CONCLUSION: Ambulant participants with CP, as well as TD youth must be encouraged to take more breaks from being sedentary and include more frequent and longer upright events.

A Preliminary Study of Dual-Task Training Using Virtual Reality: Influence on Walking and Balance in Chronic Poststroke Survivors.

BACKGROUND: Stroke is a leading cause of death and disability in the Western world, and leads to impaired balance and mobility. OBJECTIVE: To investigate the feasibility of using a Virtual Reality-based dual task of an upper extremity while treadmill walking, to improve gait and functional balance performance of chronic poststroke survivors. METHODS: Twenty-two individuals chronic poststroke participated in the study, and were divided into 2 groups (each group performing an 8-session exercise program): 11 participated in dual-task walking (DTW), and the other 11 participated in single-task treadmill walking (TMW). The study was a randomized controlled trial, with assessors blinded to the participants' allocated group. Measurements were conducted at pretest, post-test, and follow-up. Outcome measures included: the 10-m walking test (10 mW), Timed Up and Go (TUG), the Functional Reach Test (FRT), the Lateral Reach Test Left/Right (LRT-L/R); the Activities-specific Balance Confidence (ABC) scale, and the Berg Balance Scale(BBS). RESULTS: Improvements were observed in balance variables: BBS, FRT, LRT-L/R, (P < .01) favoring the DTW group; in gait variables: 10 mW time, also favoring the DTW group (P < .05); and the ABC scale (P < .01). No changes for interaction were observed in the TUG. CONCLUSIONS: The results of this study demonstrate the potential of VR-based DTW to improve walking and balance in people after stroke; thus, it is suggested to combine training sessions that require the performance of multiple tasks at the same time.

The Game of Life soccer program: Effect on skills, physical fitness and mobility in persons with intellectual disability and autism spectrum disorder.

BACKGROUND: Soccer is the world's most popular sport. The present authors evaluated the effect of the Game of Life (GOL) soccer initiative on soccer skills, fitness and mobility of adults with intellectual disability (ID) and autism spectrum disorder (ASD). METHODS: The programme is comprised of once-weekly sessions. OUTCOMES: soccer skills, fitness and mobility. Effectiveness was evaluated using within-/between-group analyses (e.g. effect size, ES). RESULTS: Fifty adults with intellectual disability and 19 with ASD (age = 31.80 ± 10.11) participated in this study. From pre-test to post-test, the intellectual disability group improved their soccer skills (ES = 0.437); physical fitness-the intellectual disability group presented trivial ESs, whereas the ASD group showed moderate-to-large ESs; Mobility-only the ASD group presented a significant improvement (ES=-0.435), and the intellectual disability group presented better ability in most outcomes in pre- and post-tests. CONCLUSION: The findings indicated differences in entry-level performance and training impact between the two groups. This should be considered when developing training programmes for soccer players.

Student Attitudes Toward Inclusion in Physical Education: The Impact of Ability Beliefs, Gender, and Previous Experiences.

This study addresses the associations between students' ability beliefs and attitudes toward inclusion in physical education, as well as the impact of gender and previous contact/participation with children with disability on these variables. A cross-sectional study was conducted with 976 students (491 girls and 485 boys; age 11-16 years), who responded to ability beliefs and attitudes questionnaires. Ability beliefs (entity and incremental) and the 3 sociodemographic variables predicted 20.4% and 9% of the behavioral and cognitive subscales of attitudes, respectively. Students with higher scores for entity beliefs of ability had a less favorable attitude toward inclusion. Girls reported more favorable attitudes toward inclusion than boys. Students who indicated previous participation in physical activities with children with disabilities showed attitudes that were more favorable in both the behavioral and cognitive subscales, while those who reported previous contact had more favorable attitudes in the behavioral subscale and lower entity beliefs. However, the 3 sociodemographic variables had a lower contribution to the explained variance of attitudes.

[PHYSICAL EXERCISE FOR PEOPLE WITH MULTIPLE SCLEROSIS: EFFECTS, RECOMMENDATIONS AND BARRIERS].

This review summarizes the existing knowledge regarding the effects and recommendations for physical training (PTr) in patients with multiple sclerosis (MS). In addition, perceived benefits and barriers to PTr in this population are reviewed. One of the primary aims of rehabilitation for patients with MS is to increase their levels of activity and independence. PTr is a central component in the rehabilitation process. Nonetheless, the use of PTr in the rehabilitation of patients with MS has been a controversial issue for years. Nowadays, strong evidence exists that aerobic training in individuals with MS has a positive effect on overall physical conditioning, gait speed, fatigue, depression and cognition. Unlike aerobic training, the number of studies that investigated strength training effects in this population is limited. However, the available data show that resistance training also has beneficial effects on MS patients. It is important to note, that PTr has no deleterious effects in MS patients. In the various studies, there was diversity with regard to the duration and the frequency of PTr, while intensity was often poorly described. It is recommended that individuals with MS engage in aerobic training (at 60-80% of maximal heart rate), strength training (1-3 sets of 8-15 repetitions), the range of motion, balance and ambulation exercises. Awareness of the benefits of physical activity and sense of achievement are not sufficient to promote exercise participation in persons with MS. Factors relating to physical exertion, sports facilities availability and self-efficacy play an important role in promoting exercise participation.

[PHYSICAL EXERCISE AFTER STROKE: EFFECTS, RECOMMENDATIONS AND BARRIERS].

This review summarizes the knowledge regarding the effects and recommendations for physical training (PTr) post-stroke. In addition, perceived benefits/barriers to PTr post-stroke are reviewed. PTr is an important post-stroke rehabilitation goal. Before beginning a PTr program it is recommended to conduct a physical examination. There is evidence that aerobic training post-stroke has a positive effect on gait and on risk factors for recurrent stroke. Similarly, strength training is also safe and effective. However, this training modality does not improve.gait functions. Neuromuscular training post-stroke is also a recommended training method. In the various studies conducted, there was diversity with regard to duration and frequency of PTr. It is recommended that individuals post-stroke engage in aerobic training 3-5 days a week. During the acute phase, the rating of perceived exertion should be "fairly light" (less or equal to 11 on the Borg scale, which ranges 6-20). In more advanced phases of recovery, one ca exercise at a higher intensity of up to "somewhat hard" (rating of perceived exertion 11-14; 55-80% of maximal heart rate). It is also recommended to conduct strength training (2-3 days per week, 1-3 sets of 10-15 repetitions), and flexibility and neuromuscular training (2-3 days per week). In order to encourage individuals post-stroke to conduct PTr there is a need for social support (from caregivers and family) and to provide PTr consultation. PTr barriers consist of both personal (e.g., depression, knowledge regarding physical activity centers) and environmental (e.g., lack of transportation) factors.

[Physical exercise for people with cerebral palsy: effects, recommendations and barriers].

The management goal of cerebral palsy (CP) is improving functionality, locomotion and independence. Treatment programs commonly encompass adapted physical activity (APA). This review summarizes the knowledge regarding the effects and recommendations for APA in persons with CP. In addition, barriers to APA in this population are reviewed. The available literature on benefits of APA to persons with CP has focused mainly on youth. The components of the APA programs generally consist of strength, aerobic and flexibility training. There is no empirical evidence that strength-training increases spasticity in people with CP. Furthermore, strength-training may increase strength and the ability to perform daily activities. Aerobic-training is especially important as persons with CP typically have low cardiorespiratory fitness and high prevalence of cardiac disease. However, limited published evidence exists on aerobic-training effects in this population. Nonetheless, the evidence suggests that aerobic-training in persons with CP can improve physiological outcomes, yet the influence of these changes on participation has not been investigated sufficiently. Stretching exercise is a common treatment for spasticity. Surprisingly, there is inconclusive evidence for the effectiveness of stretching exercise for persons with CP. Despite the importance attributed to APA for people with CP, low levels of physical activity have been reported in this population. However, when caregivers perceive greater benefits of exercise, individuals with CP are more likely to be active. In contrast, barriers to APA include costs of APA programs, limited means of transportation to APA facilities, lack of information regarding APA facilities and limited appropriate exercising equipment in the APA facilities.

Remote Pilates Training Is Effective in Improving Physical Fitness in Healthy Women: A Randomized Controlled Study.

Despite its positive impact on physical and mental well-being, adults may refrain from performing regular physical activity, due to inadequate time, accessibility, or funds. Yet remote platforms could overcome such obstacles and increase participation. This study evaluated the effectiveness of remote-synchronous group-Pilates classes compared to in-studio classes in healthy sedentary women. In a randomized controlled design, 40 women, aged 20-45, were assigned to a Zoom or studio group-Pilates training. The intervention included twice-weekly 45 min sessions over an eight-week period. Attendance (adherence) was recorded, and the participants completed physical motor tests (plank, curl-up, stork, push-up, and V-sit and reach), Profile of Mood State Surveys, and Nordic Musculoskeletal Pain Questionnaires. Evaluations were performed at baseline, mid-intervention (4 weeks), and post intervention (8 weeks). Adherence to training was high in the Zoom and studio groups (80% and 74%, respectively). Improvements in physical motor tests were seen in both groups following the Pilates interventions, thereby indicating the effectiveness of group-Pilates Zoom training. In conclusion, remote online physical activity such as Pilates offers a good alternative to in-studio trainings, as a means for improving physical fitness and promoting a healthy lifestyle in adults, by offering a more accessible and less timely alternative to in-studio physical activity programs.

Creation and validation of the self-efficacy instrument for physical education teacher education majors toward inclusion.

The purpose was to validate a self-efficacy (SE) instrument toward including students with disability in physical education (PE). Three scales referring to intellectual disabilities (ID), physical disabilities (PD), or visual impairments (VI) were administered to 486 physical education teacher education (PETE) majors. The sample was randomly split, and exploratory and confirmatory factor analyses (EFA and CFA, respectively) were conducted. After deleting items that did not meet inclusion criteria, EFA item loadings ranged from 0.53 to 0.91, and Cronbach's alpha reliability was high (for ID = .86, PD = .90, and VI = .92). CFA showed that the ID scale demonstrated good goodness-of-fit, whereas in the PD and in the VI scales demonstrated moderate fit. Thus, the content and construct validity of the instrument was supported.

Advances in Technology Promote Patient-Centered Care in Cardiac Rehabilitation.

Patient-centered health care (PCC) is a framework of clinical care focused on the patient's individual health care needs. In particular, it emphasizes the development of a partnership between the patient, physician, and healthcare workers to actively involve and empower the patient in their health care decisions. Additionally, PCC goals include ensuring access to care, emotional support, engaging patient support systems, physical comfort, and continuity of care. Technology also provides a platform to engage patients and their families in their care and can be a useful tool to gauge their level of interest, knowledge, and motivations to adequately educate them on the many factors that contribute to their disease, including diet, exercise, medication adherence, psychological support, and early symptom detection. In this article, we summarize the importance of technology in promoting PCC in cardiac rehabilitation and the impact technology may have on the different aspects of patient and physician relationships. Modern technological devices including smartphones, tablets, wearables, and other internet-enabled devices have been shown to help patient-staff communication, cater to patients' individual needs, increase access to health care, and implement aspects of PCC domains.

Promoting Physical Activity Among Children and Adolescents With Disabilities: The Translation of Policy to Practice Internationally.

BACKGROUND: Physical inactivity among children and adolescents with disabilities (CAWD) is a global public health issue. Policy efforts to promote physical activity (PA) among CAWD have increased. This study summarizes the international policy trend for promoting PA among CAWD, with behavioral and policy insights specific to CAWD from country/regional indicators from the Active Healthy Kids Global Alliance Matrix on Physical Activity for Children and Adolescents to determine policy translation into practice. METHODS: International and national PA policy documents on CAWD were assessed. Data from the Global Matrix Para Report Cards on the behavioral and government indicators from 14 countries or regions (grouped by human development index) were reviewed and compared. RESULTS: Policy instruments began promoting PA for CAWD in 1989 via the Convention on the Rights of the Child. International policy has been advocating PA specifically for CAWD recently. In 2020, the World Health Organization published specific PA guidelines for CAWD. Data from the 14 Para Report Car found 14 grades on the average behavioral indicator and 12 on the government indicator. A gap between the average behavioral indicator (D-) and the government indicator (C+) was found in the Para Report Card data. CONCLUSIONS: Although international policies are consistent in their attention to the needs of CAWD, national/regional policies vary. Coverage ranges from nonexistent to embedded in broader inclusion concepts. A gap in policies to promote PA of CAWD is prevalent and is more prominent in countries or regions with a lower human development index ranking.

Evidence-based practice and research: a challenge to the development of adapted physical activity.

Evidence-based practice (EBP) is a growing movement in the health and educational disciplines that recommends emphasis on research outcomes during decision making in practice. EBP is made possible through evidence based research (EBR), which attempts to synthesize the volume and scientific rigor of intervention effectiveness. With the purpose of assessing the impact of this movement on adapted physical activity, this article (a) describes EBP/EBR and outlines its methodological development, (b) provides an historical perspective of EBP/EBR in APA, (c) examines EBR quality indicators in the review literature published in Adapted Physical Activity Quarterly, (d) identifies and synthesizes thematic domains appearing in these review articles, and (e) discusses practical examples of professional issues in APA arising from a lack of EBR.

Soccer-specific endurance and running economy in soccer players with cerebral palsy.

The purpose of this study was to describe running economy, soccer specific endurance, and selected kinematic running criteria in soccer players with cerebral palsy (SPCP) and to compare them with values of position-matched players without CP. Fourteen international, male soccer players with cerebral palsy completed the "Yo-Yo" intermittent recovery run level 1 (IRL-1) test to assess soccer-specific endurance and a submaximal running test on a treadmill to determine running economy. The mean IRL-1 distance covered by the SPCP of the Irish CP team was found to be 43-50% below the mean distance attained by position-matched soccer players without disability, while running economy was found to be within the range of that reported for able-bodied athletes. No relationship could be found between the level of CP-ISRA classification and soccer-specific endurance or running economy in this group of elite level SPCP. Though small in number, these data support a further examination of the relationship between CP classification and sport-specific performance.