Prescribing exercise for children with disabilities: Unique considerations and precautions

June 04, 2021

Nota: este contenido se creó antes de la pandemia de la enfermedad por coronavirus 2019 (COVID-19) y no describe los protocolos adecuados para la pandemia. Respeta todas las pautas recomendadas por los Centros para el Control y la Prevención de Enfermedades relativas al uso de mascarillas y al distanciamiento físico.

The rise in obesity among all children has been associated with increases in health conditions previously seen only in adults, including hypertension, type 2 diabetes mellitus and unhealthy lipid profiles. Overall, individuals with childhood-onset disabilities are at increased risk of earlier onset of age-related health changes. In children with neuromuscular conditions, for example, a sedentary lifestyle can lead to earlier onset of cardiovascular, metabolic and musculoskeletal issues. Multiple studies have also shown that adults with cerebral palsy have higher rates of chronic medical conditions such as coronary artery disease, diabetes, joint pain and hypertension than do age-matched peers without cerebral palsy.

As providers grapple with how to address these trends, it's important to remember that many children with disabilities can safely participate in regular physical activity and derive the same physiologic and psychosocial benefits that children without disabilities experience, including maintaining a healthy weight and cardiovascular fitness into adulthood.

In a review article published in Current Physical Medicine and Rehabilitation Reports in 2019, lead author Sherilyn W. Driscoll, M.D., and co-authors discuss the important role that exercise can play in the overall health and fitness of children with disabilities, and they provide an updated overview of disability-specific exercise recommendations and precautions for providers to consider. Dr. Driscoll is a pediatric physiatrist at Mayo Clinic's campus in Rochester, Minnesota, who directs Mayo Clinic Children's Center Pediatric Rehabilitation division and serves as the medical director for the Pediatric Rehabilitation Inpatient Unit.

"We know that exercise is truly good for every body," says Dr. Driscoll. "But we also need to acknowledge that children with disabling conditions, who are also susceptible to the obesity epidemic, are even less likely to participate in structured or recreational physical activities than their typically developing peers. So discussions about activity and exercise are an essential part of any evaluation and care plan we develop for these children."

Individualized exercise recommendations for children and adolescents

Dr. Driscoll and co-authors acknowledge that multiple personal and environmental barriers to participation exist, including fear, lack of motivation, perceived negative attitudes toward disability, lack of transportation, availability of appropriate facilities or programs, and cost.

In addition to these barriers to participation, children and adolescents with disabilities experience a wide range of functional abilities and medical concerns. Consequently, providers must individualize exercise and activity recommendations to each patient. The goal for children who are able is to follow the guidelines for children and adolescents outlined in the Physical Activity Guidelines for Americans released by the U.S. Department of Health and Human Services. These guidelines include 60 minutes or more of physical activity a day, with three days a week of activity performed at a vigorous level and three days a week of strengthening activities.

Recomendaciones y pautas específicas sobre el diagnóstico y la discapacidad
Diagnosis- and disability-specific recommendations and guidelines

The chart highlights a few of the diagnosis- and disability-specific recommendations and guidelines for children that Dr. Driscoll and co-authors present in their review article.

Conclusions

Overall, Dr. Driscoll and colleagues emphasize that the benefits associated with physical activity and the health risks associated with sedentary behavior in this population are significant.

"Although some individuals will require special precautions for safety or adaptations to permit participation, physical activity and exercise have been proved to be safe and effective for most children and adolescents with disabilities," says Dr. Driscoll.

Dr. Driscoll and co-authors are hopeful that future research will help expand and update activity guidelines for specific diagnoses and offer additional guidance about how best to engage children and adolescents with disabilities in these activities.

For more information

Driscoll SW, et al. Exercise in children with disabilities. Current Physical Medicine and Rehabilitation Reports. 2019;7:46.