Examining Ableism Through the Physical Activity Experiences of Blind and Visually Impaired Women.

PURPOSE: This study examined how ableism influences blind and visually impaired women's experiences accessing and engaging in exercise, physical activity, and sport. METHODS: Ten women between the ages of 27 and 45 years completed a one-on-one audio-recorded virtual interview where they reflected on the meaningfulness of their exercise, physical activity, and/or sport experiences, as well as described any experiences related to direct, indirect, systemic, or internalized ableism within or when attempting to access those physical activity experiences. The interview transcripts were analyzed using reflexive thematic analysis. FINDINGS: The analysis resulted in the construction of 2 themes that depicted the participants' experiences: (1) "It's exhausting": navigating inaccessibility and (2) "You feel like a fish out of water": internalized ableism. DISCUSSION: The themes highlight the participants' experiences which were largely focused on being forced to navigate inaccessible environments which resulted in exhaustion and expressions of internalized ableism. These findings provide insight into what makes and does not make a physical activity space accessible and welcoming for blind and visually impaired adults.

Prevalence of meeting 24-hour movement guidelines and its associations with health indicators in people with disabilities: A systematic review and meta-analysis.

BACKGROUND: Meeting the 24-h movement guidelines (i.e., physical activity, sedentary behavior, sleep) could generate health benefits to people with disabilities. However, no systematic reviews or meta-analyses have examined the prevalence of meeting these guidelines and associations with health indicators in this group. OBJECTIVE: This systematic review and meta-analysis aimed to examine the prevalence of meeting the 24-h movement guidelines and associations with health indicators among people with disabilities. METHODS: Six electronic databases were searched for studies published in English from inception to May 31, 2023. Meta-analyses with the random-effects model were used to determine the prevalence of meeting the 24-h movement guidelines. Qualitative syntheses were employed to describe the associations between meeting the guidelines and health indicators. RESULTS: Twenty-four studies comprising 77510 participants (41.6% females) with disabilities aged 6-65 years from eight countries were identified. Overall, 6.97% of the participants with disabilities met all 24-h movement guidelines, and 16.65% met none of the guidelines. Significant age (P = 0.006) and disability type (P = 0.001) differences were found in meeting all guidelines. Participants with disabilities who met all guidelines reported better psychosocial health indicators (9/9 studies) than those met none or only one of the guidelines. There was limited evidence or research for other health indicators. CONCLUSION: There is some evidence showing that the prevalence of meeting all 24-h movement guidelines in people with disabilities is low. Meanwhile, there is preliminary evidence suggesting that meeting all guidelines is associated with better psychosocial health than meeting none of the guidelines.

The impact of the physical activity intervention on sleep in children and adolescents with autism spectrum disorder: A systematic review and meta-analysis.

Pharmacological treatments (i.e., melatonin) and non-pharmacological therapies (e.g., parent-based sleep education programs and behavioural interventions) have been found to result in improved sleep in children and adolescents with autism spectrum disorder (ASD). However, there are several limitations to these treatment approaches, including concerns about the possible side-effects and safety, high-cost and uncertainties of long-term effects. Physical activity (PA) intervention is a promising behavioural intervention that has received increasing attention. However, the effects of PA intervention on sleep are still unclear in this clinical group. This study aimed to synthesize available empirical studies concerning the effects of PA interventions on sleep in children and adolescents with ASD. Following PRISMA guidelines, seven electronic databases: APA PsychInfo, CINAHL Ultimate, ERIC, MEDLINE, PubMed, SPORTDiscus, and Web of Science, were searched from inception to March 2023. Randomized controlled trials/quasi-experimental designs with comparison groups were included. Initially, 444 articles were identified, 13 articles underwent systematic review, and 8 studies with control groups and sufficient statistical data were selected for meta-analysis. Compared to no-treatment control groups, PA interventions had a large positive effect on parent-reported general sleep problems, night awakenings, sleep resistance, sleep duration and actigraphy-assessed sleep efficiency in children and adolescents with ASD.

"I Can Do It": Perceived Competence of Parents of Autistic Children After Participating in a Physical Activity Intervention.

BACKGROUND: Autistic children can benefit from physical activity (PA) in a variety of ways. However, autistic children tend not to meet PA recommendations and, consequently, may not experience the associated benefits. Parental PA support can facilitate PA participation among autistic children, but parents of autistic children may lack the skills to help their child engage in PA. Few studies, to date, have examined the outcomes of parent-mediated PA interventions for autistic children. The purpose of this study was to explore parents' perceived behavioral control (PBC) to support their autistic children in PA after their participation in a PA intervention. METHODS: The theory of planned behavior served as the framework for this descriptive-qualitative investigation. Fifteen parents (each with 1 autistic child in the intervention) participated in semistructured interviews (3 wk after the intervention), which were transcribed and then analyzed using thematic line-by-line analysis. RESULTS: Three themes characterized the changes to parents' PBC after completing the PA intervention. Those themes were: (1) I learned by son! (2) You are my coach! and (3) I can do it! CONCLUSIONS: The results showed that by participating in a parent-mediated PA intervention, parents experienced improved confidence and awareness of their child's abilities, thus enhancing their PBC. Future research is needed to examine how these improvements in PBC may influence the actual PA behaviors of autistic children.

Meeting 24-h movement behavior guidelines is linked to academic engagement, psychological functioning, and cognitive difficulties in youth with internalizing problems.

BACKGROUND: This study aimed to investigate associations of meeting 24-h movement behavior (24-HMB: physical activity [PA], screen time [ST] in the school-aged youth, and sleep) guidelines with indicators of academic engagement, psychological functioning, and cognitive function in a national representative sample of U.S. youth. METHODS: In this cross-sectional study, 1794 participants aged 6 to 17 years old were included for multivariable logistic regression to determine the above-mentioned associations, while adjusting for sociodemographic and health covariates. RESULTS: The proportion of participants who met 24-HMB guideline(s) varied greatly (PA+ ST+ sleep = 34 [weighted 1.17 %], PA + ST = 23 [weighted 1.72 %], PA + sleep = 52 [weighted 2.15 %], PA = 34 [weighted 2.88 %], ST = 142 [weighted 7.5 %], ST+ sleep = 209 [weighted 11.86 %], sleep = 725 [weighted 35.5 %], none = 575 [weighted 37.22 %]). Participants who met ST guideline alone and integrated (ST + Sleep and ST + sleep + PA) guidelines demonstrated the consistently beneficial associations with learning interest/curiosity, caring for school performance, completing required homework, resilience, cognitive difficulties, self-regulation (ps < 0.05). CONCLUSION: Meeting 24-HMB guidelines in an isolated or integrative manner was associated with improved academic engagement, psychological functioning, and reduced cognitive difficulties. These findings highlight the importance of the promotion of 24-HMB guidelines in youth with internalizing problems. Future longitudinal studies are needed to investigate whether changes or modifications of meeting specific 24-HMB guidelines (especially ST) is beneficial for youth with internalizing problems.

Associations between 24-h movement guidelines compliance and anxiety and depression among youth receiving special education services in the US.

BACKGROUND: Youth with disabilities are five times more likely to experience anxiety or depression than peers without disabilities. Engagement in sufficient daily physical activity (PA), adequate nightly sleep, and limited daily screen time (collectively known as 24-h movement guidelines) is associated with lower odds of anxiety and depression for peers without disabilities. Extending the investigation of these modifiable behaviors to youth with disabilities is warranted. OBJECTIVE: To estimate the association between meeting 24-h movement guidelines and anxiety and depression among a nationally representative sample of youth with disabilities. METHODS: A cross-sectional secondary analysis of the 2019-2020 NSCH was conducted and included youth 6-17 years old who were currently receiving special education services. Weighted prevalence estimates and logistic regressions were employed to estimate the association between meeting guidelines (separately and combined) and current anxiety or depression status. RESULTS: Compared to youth with disabilities who met the guideline, those not meeting the sleep or screen time guidelines, independently, had significantly higher odds of depression, or anxiety (aOR range 1.53, 2.31 respectively). Comparable odds were observed between those meeting the PA guidelines, alone or in combination, and those meeting none of the 24-h movement guidelines. CONCLUSION: Adequate nightly sleep, and limited screen time, were significantly associated with anxiety and depression among youth with disabilities, a pattern consistent to peers without disabilities. Yet, meeting more than one guideline did not further reduce odds of poor mental health, warranting further investigation of compounding benefits of the 24-h guidelines within this population.

The role of social support in the relationship between physical activity and health-related quality of life among adults with visual impairments.

BACKGROUND: Studies support assertions that more social support may be related to higher physical activity behavior, which may, in turn, relate to higher health-related quality of life (HRQoL). However, these relationships remain unexplored, particularly among adults with visual impairments. OBJECTIVE: The purpose of this study was to examine the relationships between physical activity-specific social support, physical activity participation, and HRQoL among adults with visual impairments. METHODS: This cross-sectional study utilized an online survey methodology. Adults with visual impairments (n = 251) were recruited via three visual impairment LISTSERVs housed in the USA and completed four questionnaires. Data were analyzed using (a) a descriptive analysis, (b) one sample t-test, and (c) structural equation modeling to examine the relations among social support, physical activity, and HRQoL components. RESULTS: The participants reported relatively low weekly physical activity participation, with mean physical activity about 1362.02 ± 1231.37 MET-min/week. Compared to the mean T-scores of the general adult US population, the participants had significantly lower physical (43.56 ± 6.76, t = -15.10, p < .01) and mental components of HRQoL (38.24 ± 11.37, t = -16.39, p < .01). Structural equational modeling results show that social support positively predicted weekly physical activity participation (ß = 0.11), which, in turn, predicted physical component (ß = 0.12) but not mental component HRQoL (ß = 0.04, p > .05). CONCLUSIONS: Our participant sample reported significantly lower HRQoL than the general US populations. The findings suggest that social support can both directly and indirectly, through physical activity, influence psychological HRQoL among adults with visual impairments.

Prevalence of Bullying Victimization and Perpetration Among Youth with Chronic Health Conditions in the United States.

Background: Bullying perpetration and victimization have gained widespread recognition as major public health issues. However, few studies focused on exploring prevalence rates across impairments or chronic health conditions exist in the literature. The primary purpose of this analysis was to provide current estimates of bullying victimization and perpetration among US youth with 24 chronic health conditions. A secondary purpose was to examine associations between the number of chronic health conditions and bullying victimization and perpetration. Methods: Data from the 2019-2020 National Survey of Children's Health, nationally representative cross-sectional probability sample of noninstitutionalized youth, were used. This study focused on 29,285 adolescents (aged 12-17 years), including 14,203 with a chronic condition. Pearson's χ2 tests were used to examine proportional equivalence on bullying perpetration and victimization, and logistic regression analyses were used to explore associations between the number of chronic conditions and bullying behaviors. Results: A significantly higher proportion of adolescents with chronic health conditions engaged in bullying perpetration and victimization compared to those without a chronic health condition. Those with autism spectrum disorder, developmental delay, and depression were noted as having elevated proportions of bullying victimization, whereas those with behavioral or conduct problems, blood disorders, and depression had higher rates of perpetration. Conclusions: This analysis helps to identify several groups of adolescents in need of targeted interventions to help reduce bullying rates. Those experiencing more than one chronic health condition were 3.56 and 2.97 times as likely to engage in bullying victimization and perpetration, respectively, compared to those with no condition.

Barriers and Challenges for Visually Impaired Students in PE-An Interview Study with Students in Austria, Germany, and the USA.

Physical education (PE) is an important part of school education worldwide, and at the same time, almost the only subject that explicitly deals with body and movement. PE is therefore of elementary importance in the upbringing of young people. This also applies to children with visual impairments. However, existing findings on participation and belonging in PE as well as on physical and motor development reveal that this group of children and adolescents is noticeably disadvantaged in this respect. Against this background, this paper aims to explore fundamental barriers and challenges across different types of schools, types of schooling, and countries from the perspective of visually impaired children. The qualitative interview study with 22 children with visual impairments at different types of schools in three countries (Austria, Germany, USA) reveals that none of the respondents could escape the power of social distinctions and related problematic and existing hierarchies. Hence, ideas of normality and associated values remain the main challenge for all of them. However, the type-forming analysis provides important insight across settings on how visually impaired children differ on this, allowing for greater sensitivity to the concerns of children with visual impairments.

Age-Related Differences in Accelerometer-Assessed Physical Activity and Sleep Parameters Among Children and Adolescents With and Without Autism Spectrum Disorder: A Meta-Analysis.

Importance: Physical inactivity and sleep disorders are health-related concerns of youth with autism spectrum disorder (ASD) that can persist from childhood and exacerbate core symptoms. However, evidence on group differences in accelerometer-assessed physical activity and sleep parameters among youth with and without ASD is inconclusive and age-specific effects remain unclear. Objective: To synthesize evidence on group differences in accelerometer-assessed physical activity and sleep parameters and examine the moderating effects of age between children and adolescents with and without ASD. Data Sources: American Psychological Association PsychInfo, CINAHL Ultimate, ERIC, MEDLINE, SPORTDiscus with Full Text, and Web of Science from inception to February 2023. Study Selection: Two independent reviewers screened articles for observational research comparing accelerometer-assessed physical activity levels and sleep parameters in children and adolescents with and without ASD. Data Extraction and Synthesis: After developing a standardized form, relevant data were extracted. Quality was assessed using the McMaster Critical Review Form and rated based on sample, measurement, and analyses. The Preferring Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. Main Outcomes and Measures: The primary outcomes were actigraphy-measured MVPA, sleep latency, sleep efficiency, total sleep time, and wake after sleep onset. Data were pooled using a random-effects model. Hedges g was used to express the effect size index. Meta-regression on age was also performed to investigate the potential moderating effects. Results: Collectively, 1757 studies were initially identified. Among 104 articles that were assessed, 28 were included, comprising moderate-to-vigorous physical activity (MVPA), 4 sleep parameters, and 73 independent effect sizes. A total of 28 studies were included in analysis, comprising 805 children and adolescents with ASD and 1573 without ASD (age range, 5.1-16.9 years). Compared with peers without ASD, children and adolescents with ASD had a small-to-moderate difference in MVPA (g = -0.450; 95% CI, -0.622 to -0.277), total sleep time (g = -0.332; 95% CI, -0.574 to -0.090), sleep efficiency (g = -0.424; 95% CI, -0.645 to -0.203), and a moderate difference in sleep latency (g = 0.514; 95% CI, 0.351 to 0.677) measured by actigraphy. Children and adolescents with ASD experienced an age-related decline in moderate-to-vigorous physical activity (ß = -0.049 [95% CI, -0.097 to -0.001]; P = .045), indicating that younger children with ASD showed a smaller difference in MVPA compared with their peers without ASD. Moderating effects of age on sleep parameters were not significant. Conclusions and Relevance: The findings of this meta-analysis suggested that children and adolescents with ASD had lower MVPA and worse sleep than peers without ASD, and the difference in MVPA varied with age. These findings reinforce the need for public health initiatives aimed at reducing these group disparities.

Effects of Peer-Supported and Self-Guided Exercise on Self-Reported Anxiety and Depression among Young Adults-A Pilot Study.

Mental health conditions such as anxiety and depression became heightened issues for college-aged young adults during the global pandemic. The main purpose of this study was to examine the effects of a peer-supported exercise intervention on young adults (vs. self-guided exercise) who reported elevated levels of anxiety and/or depression. A parallel group design was used where young adults (n = 27) were randomly assigned to either a peer-supported or self-guided exercise group which lasted for eight weeks. The generalized anxiety and depression subscales of the Counseling Center Assessment of Psychological Symptoms (CCAPS-34) were measured for a baseline and then at 4-week, 8-week, and 12-week follow-up. Analyses of covariance (ANCOVA) with repetitive measures show that peer-supported and self-guided exercise programs reduced participant anxiety and depression scores; however, intervention decay for the peer-supported exercise intervention was more severe than that for the self-guided group. Self-guided exercise had a longer-lasting effect than the peer-supported alternative and could be a cost-effective approach to combat anxiety and depression issues among young adults.

Physical activity of children with visual impairments: intentions and behaviors of parents post intervention.

PURPOSE: Physical activity (PA) can provide multiple benefits for children with visual impairments (VI). To date, little research has explored the retention effects of PA interventions for children with VI. Thus, the purpose of this study was to explore the PA experiences of parents of children with VI three months after completing a PA intervention. METHOD: This descriptive-qualitative study was situated in the Theory of Planned Behavior. Five parents completed semi-structured interviews that were transcribed and analyzed using a thematic line-by-line analysis. RESULTS: Four themes characterizing how parents created PA opportunities for their children with VI were constructed: (a) Teaching from Awareness (b) Advocating for Needs, (c) Engaging Family through Community, and (d) Seeking More PA Opportunities. CONCLUSION: Parent's awareness of their child's abilities, parents' advocacy, and parents' teaching skills all helped to expose their children to new types of PA in the community. Parents reflected about a lack of consistently offered community-based PA for their children. Researchers must consider the importance of educating parents on how to teach skills, increase awareness, and advocate for more community-based PA programs.IMPLICATIONS FOR REHABILITATIONThree months after a physical activity intervention for children with visual impairments, parents' awareness of their child's abilities, advocacy, and competence teaching motor skills helped to expose their children to new types of physical activities in the community and at home.The lack of consistently offered community-based physical activities for children with visual impairments calls for rehabilitation professionals to create or promote existing physical activity programs for children with visual impairments.Rehabilitation professionals should explore how physical activity programs can address barriers faced by participants (e.g., lack of knowledge, lack of physical activity equipment), and offer a continuum of activities and programming for these families in the home and community setting.Rehabilitation professionals should educate parents on the importance of physical activity, how to teach motor skills, and advocate for more community-based physical activity programs for their children with visual impairments.

U.S. Physical Activity Para Report Card for Children and Adolescents With Disabilities.

The U.S. Report Card on Physical Activity for Children and Youth has tracked 10 physical activity (PA) indicators common to the Active Healthy Kids Global Matrix since 2014. This article expands on the U.S. report cards by presenting PA indicator assessments among children and adolescents with disabilities. Grades for indicators were assigned based on a search of peer-reviewed articles presenting nationally representative data. The Global Matrix 3.0 benchmarks and grading framework guided the process. Grades for overall PA, sedentary behaviors, organized sports, and school were F, D+, D+, and D, respectively. Insufficient evidence existed to assign grades to the remaining six indicators. There is a need in the United States for targeted PA promotion strategies that are specific to children and adolescents with disabilities. Without a commitment to this effort across sectors and settings, the low grades identified in this para report card are expected to remain.

Environmental Correlates of Physical Activity and Screen-Time in Youth with Autism Spectrum Disorder: A Seven-Country Observational Study.

This cross-sectional observational study sought to examine the environmental correlates of physical activity and screen-time among youth with autism spectrum disorder (ASD). Parents of youth with ASD (n = 1,165) from seven countries/regions provided responses to an online survey form measuring environmental correlates (i.e., physical activity neighborhood environment, social network, social trust and cohesion, bedroom media, social home environment) and outcomes (i.e., physical activity, screen-time). Multiple linear regression analyses were conducted to determine environmental predictors of the outcomes. Physical activity neighborhood environment (B = 0.15, p = 0.047), social network (B = 0.16, p = 0.02), and social home environment (B = 1.07, p < 0.001) were significantly associated with physical activity, whereas social trust and cohesion and bedroom media were not. Further, social trust and cohesion (B = -0.14, p = 0.001), bedroom media (B = 0.10, p = 0.001), and social home environment (B = -0.16, p < 0.001) were significantly associated with screen-time while neighborhood environment and social network were not. The identified environmental attributes of physical activity and screen-time behaviors should be targeted for health promotion among youth with ASD.

Lower extremity joint stiffness of autistic adolescents during running at dual speeds.

Running is one of the most common forms of physical activity for autistic adolescents. However, research examining their lower extremity dynamics is sparse. In particular, no information exists regarding lower extremity joint stiffness in autistic adolescents. This study compared knee and ankle joint stiffness during the absorption phase of running between autistic adolescents and non-autistic controls. Motion capture and ground reaction forces were recorded for 22 autistic adolescents and 17 non-autistic age, sex, and BMI matched peers who ran at self-selected and standardized (3.0 m/s) speeds. Group × speed knee and ankle joint stiffness, change in moment, and range of motion were compared using mixed-model ANOVAs. There were no group × speed interactions for any variable. Autistic adolescents presented with significant (12 % and 19 %) reduced knee and ankle joint stiffness, respectively. In addition, autistic adolescents had significant reduced changes in knee and ankle joint moments by 11 % and 21 %, respectively, compared to their non-autistic peers. Only knee joint stiffness and knee joint moments were sensitive to running speed, each significantly increasing with speed by 6 %. Current literature suggests joint stiffness is an important mechanism for stability and usage of the stretch shortening cycle (or elastic recoil); as such, it is possible that the reduced ankle plantar flexor and knee extensor stiffness found in autistic adolescents in this study could be indicative of reduced efficiency during running. As group differences existed across both speeds, autistic adolescents may benefit from therapeutic and/or educational interventions targeting efficient running mechanics.

Feasibility and Reliability of Health-Related Physical Fitness Tests in Children and Adolescents with Hearing Impairment.

Although research supports the feasibility and reliability of health-related physical fitness (HRPF) tests in typically developing children and adolescents, little is known regarding the feasibility and reliability of these tests for those with hearing impairments (HI). The aim of this study was to evaluate the feasibility and reliability of a HRPF test battery for children and adolescents with HI. A test-retest design with a one-week interval was conducted with 26 participants with HI (mean age: 12.7 ± 2.8 years; 9 male). The feasibility and reliability of seven field-based HRPF tests (i.e., body mass index, grip strength, standing long jump, vital capacity, long distance run, sit-and-reach, one leg stand) were evaluated. All the tests showed high feasibility (completion rate > 90%). Six tests indicated good to excellent test-retest reliability (all intraclass correlation coefficient [ICC] > 0.75) while the one leg stand test showed poor reliability (ICC = 0.36). Relatively large percentages of standard error of measurement (SEM%) and minimal detectable change (MDC%) were observed in the sit-and-reach test (SEM% = 52.4%, MDC% = 145.2%) and one leg stand test (SEM% = 107.9%, MDC% = 299.2%), whereas the rest of the tests demonstrated reasonable SEM% and MDC% values. Collectively, most of the tests can be feasibly and reliably used to assess HRPF for children and adolescents with HI.

Evidence of item bias in a national flourishing measure for autistic youth.

Flourishing is a positive health indicator that aligns with strengths-based perspectives and measures within autism research. Flourishing indicators were recently included in the National Survey of Children's Health (NSCH) and have been used to evidence disparities in flourishing experienced by autistic children compared to non-autistic peers. Yet, little has been done to examine the utility of standard flourishing items for this population. This study examined the NSCH caregiver-reported flourishing items for measurement item bias. A cross-sectional, representative sample of autistic and non-autistic US children aged 6-17 years (n = 41,691) was drawn from the 2018-2019 NSCH public dataset. A confirmatory factor analysis using a multiple indicators and multiple causes model (MIMIC-CFA) was conducted to (1) test for differential item functioning (DIF; i.e., measurement bias); and (2) estimate latent mean group differences after controlling for DIF. Findings supported a 3-factor (social competence, school motivation, and behavioral control), 10-item model structure consistent with past literature, yet measurement bias was evident for 6 of the 10 items. Persistent group differences, after accounting for DIF and covariates, indicates that caregivers of autistic children perceive their children are experiencing meaningfully lower flourishing outcomes compared to caregivers of non-autistic children. However, evidence of measurement bias for items related to the social competence dimension calls into question the applicability of this measure for autistic children. Further interpretation of group differences and use of this measure should be approached with caution.

The Self-Efficacy of Physical Education Teachers to Teach Students With Disabilities: A Systematic Review of Literature.

The purpose of this article is to examine the content of previously published empirical literature utilizing self-efficacy theory with regard to physical education teachers' perceived self-confidence to teach students with disabilities in general physical education. Keyword searches were used to identify relevant literature from electronic databases published from 2000 to 2022. Twenty-four articles, from 11 countries, met all inclusion criteria, and relevant data regarding participants, theory, measurement, research design, and dependent variables were extracted. Of the 24 studies, nine were survey validation, eight were experimental, six were cross-sectional, and one was mixed-methods design. Major findings across the examined studies indicate that teachers' perceptions of training, amount of experience, and support from personnel significantly influence their self-efficacy toward teaching students with disabilities.

"Everybody Wants to be Included": Experiences with 'Inclusive' Strategies in Physical Education.

This study examined how students with orthopedic impairments experienced strategies identified in the literature to support 'inclusion'. An interpretative phenomenological analysis research approach was used, and six students with orthopedic impairments (age 10-14 years) served as participants. Data sources were written prompts, semi-structured, audiotaped interviews, and reflective interview notes. Based on thematic data analysis, four themes were constructed: "It's kind of embarrassing": experiences with support; "I don't want to be different": equipment, activity, and rule modifications; "I like to be a part of the conversation": autonomy and choice in PE; and "I would rather be like the other students": discussing disability. The experiences portrayed through these themes highlighted the differential effects of these explicated strategies, where each strategy contributed to feelings of inclusion, as well as marginalization among participants. As such, the findings indicated that 'inclusive' strategies should not be considered as blanket recommendations; instead, attempts to promote 'inclusion' of students with disabilities should start with a reflexive look at the unique needs of each individual student.