Barriers and Facilitators to Physical Activity for Youth With Cerebral Palsy
Databases: Academic One File, CINAHL, EbscoHost, ERIC, Hospitality and Tourism Complete, Google Scholar, Medline, PsycARTICLES, Psychology and Behavioral Science Collection, PsychINFO, PubMed, Science Citation Index, Social Sciences Citation Index, SPORTDiscus, Summon (Temple's electronic database system) also searched The American Therapeutic Recreation Association Annual, American Journal of Recreation Therapy, Mendeley, RT Wise Owls. Number of Sources: 9 Research Summary Regular engagement in physical activity (PA) for children and adolescents has been found to have protective health benefits by strengthening the skeletal system through weight bearing activity, assisting with weight maintenance, and enhancing psychosocial and mental health, as well as decreasing one's risk for developing secondary health problems, particularly metabolic dysfunction and cardiovascular disease (Carlon, Taylor, Dodd, Shields, 2013) Interestingly however, prolonged engagement in sedentary activity, despite the amount of weekly engagement in PA, can also negatively affect metabolic and cardiovascular systems in youth, as both systems have different cellular responses (Carlon et al. 2013) The amount of PA and sedentary time in youth with cerebral palsy (CP) is particularly concerning. A systematic review of the literature by Carlon et al. (2013) found that youth with CP participate in 30% less PA than non disabled peers according to Dutch PA guidelines that recommend one hour of daily moderate to vigorous PA for people under age 18 (World Health Organization, 2016) which is the same as U.S. PA guidelines for children and adolescents (Office of Disease Prevention and Health Promotion, 2016) The researchers also found that youth with CP engage in an average of 28.6 hours of screen time per week (hours spent in front of a TV or computer) which is double the maximum recommendation of less than two hours a day for children age 5 17 years (Australian Government Department of Health, 2014) The U.S. does not currently have sedentary guidelines. To better understand how to enhance participation in regular PA and reduce prolonged sedentary behavior in youth with CP, five qualitative studies on perceived barriers and facilitators to PA engagement for youth with CP were summarized (Conchar, Bantjes, Swartz, Derman, 2016; Lauruschkus, Nordmark, Hallstrom, 2015; Shimmell, Gorter, Jackson, Wright, Galuppi, 2013; Verschuren, Wiart, Hermans, Ketelaar, 2012; Verschuren, Wiart, Ketelaar, 2013) Individuals who took part in the studies included youth with CP who were 7 17 years old (Verschuren et al. 2012; Verschuren et al. 2013) 8 11 years old (Lauruschkus et al. 2015) 9 21 years old (Shimmell et al. 2013) 12 18 years old (Conchar et al. 2016) and their parents (Shimmell et al. 2013; Verschuren et al. 2012; Verschuren et al. 2013) The youth in the studies had varying characteristics. Some were able to understand and respond to interview questions (Conchar et al. 2016; Shimmell et al. 2013; Verschuren et al. 2012; Verschuren et al. 2013) whereas others were not, and parents responded on the participants' behalf (Shimmell et al. 2013) The participants also varied in having mild to profound motor function limitations (Lauruschkus et al. 2015) mild to profound cognitive dysfunction (Lauruschkus et al. 2015) and ranged from I to V on the Gross Motor Function Classification System Extended Revised (GMFCS E&R) (Lauruschkus et al. 2015, Verschuren et al. 2012; Verschuren et al. 2013) Some of the participants were able to ambulate without assistance or without the use of an assistive device (Conchar et al. 2016; Verschuren et al. 2012; Verschuren et al. 2013) whereas others required the use of a wheelchair or assistive ambulatory device for mobility (Conchar et al. 2016; Lauruschkus et al. 2015) Some of the participants also utilized augmentative or alternative communication (Lauruschkus et al. 2015) All five of the studies explored personal and environmental facilitators and barriers to engagement in PA for youth with CP (see Figure 1) The findings from each study were compiled into a table and category themes were identified. In total, 30 personal barriers and 20 personal facilitators were identified, falling into two subcategories of physiological and psychological factors. Additionally, 30 environmental barriers and 23 environmental facilitators were identified, falling into five subcategories of parental factors, opportunities for sport and PA, practical feasibility, social environment, and facility/program factors.