Expert Appraisal of the 2022 Canadian Para Report Card on Physical Activity for Children and Adolescents With Disabilities

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Kelly P. Arbour-Nicitopoulos Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada

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Nicholas Kuzik Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada

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Leigh M. Vanderloo Department of Science and Evaluation, ParticipACTION, Toronto, ON, Canada

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Kathleen A. Martin Ginis Department of Medicine, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada

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Maeghan E. James Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada

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Rebecca L. Bassett-Gunter Disability Advisory Research Team (DART), ParticipACTION, Toronto, ON, Canada
School of Kinesiology and Health Science, York University, Toronto, ON, Canada

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Daniela Ruttle Disability Advisory Research Team (DART), ParticipACTION, Toronto, ON, Canada

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Pinder DaSilva Disability Advisory Research Team (DART), ParticipACTION, Toronto, ON, Canada
Abilities Centre, Whitby, ON, Canada

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Katerina Disimino Disability Advisory Research Team (DART), ParticipACTION, Toronto, ON, Canada
School of Kinesiology and Health Science, York University, Toronto, ON, Canada

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Christine Cameron Canadian Fitness and Lifestyle Research Institute, Ottawa, ON, Canada

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Mike Arthur Active Living Alliance for Canadians With a Disability, Ottawa, ON, Canada

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Keiko Shikako Disability Advisory Research Team (DART), ParticipACTION, Toronto, ON, Canada
School of Physical & Occupational Therapy, McGill University, Montréal, QC, Canada

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Amy E. Latimer-Cheung Disability Advisory Research Team (DART), ParticipACTION, Toronto, ON, Canada
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Free access

This report provides an expert appraisal of the Canadian Para Report Card on physical activity (PA) for children and adolescents with disabilities. Thirteen indicators were graded by a panel of researchers, representatives from disability and PA organizations, and parents of children and adolescents with disabilities using benchmarks of the Global Matrix 4.0 and previous Canadian PA Report Cards. Facilitated panel discussions were used to appraise the available evidence based on data gaps, opportunities, and recommendations. The available data sources included four nationally generalizable or representative data sets. Grades were assigned to 8/13 indicators and ranged from B+ to F. Data gaps in measurement and national surveillance systems were identified. Ableism was an issue identified within some of the reporting benchmarks. The absence of PA from existing accessibility legislation in Canada was a policy gap of concern. Recommendations related to research, surveillance, and policy are provided to enhance PA among children and adolescents with disabilities in Canada.

In Canada, 4% of children and 13% of adolescents experience disability (Statistics Canada, 2011, 2018). Participation in physical activity (PA) provides health and developmental benefits for all children and adolescents (Murphy & Carbone, 2008). In 2010, Canada ratified the United Nations Convention on the Rights of Persons with Disabilities (2008), making a commitment to ensure equality and nondiscrimination of persons with disabilities in all areas, including education and recreation. Provincial and territorial accessibility acts also exist, and in 2019, the national Accessible Canada Act was passed (Minister of Justice, 2022), with the aim of eliminating barriers in employment, the built environment, information and communication technologies, customer service, programs/services, and transportation by 2040. The Framework for Recreation in Canada (Canadian Parks and Recreation Association/Interprovincial Sport and Recreation Council, 2015) and the Canadian Sport Policy (Sport Canada, 2012) emphasize inclusion and access, among other priorities, to enable all Canadians to participate in sport and recreation. Yet, many social, institutional, community, and policy barriers continue to limit the participation of Canadian children and adolescents with disabilities (CAWD) in PA (Martin Ginis et al., 2016).

For almost two decades, the ParticipACTION Report Card on PA for Children and Youth has been disseminated across Canada. Using available data from national surveillance and peer-reviewed literature, this Canadian Report Card provides a timely update on PA participation rates, as well as sedentary and sleep behaviors, among Canadian children and adolescents. It also grades characteristics of the environment important for supporting PA, and government strategies and investments for PA of children and adolescents. Report Card data spanning from 2015 to 2020 indicate that Canadian children and adolescents are “moving too little,” based on low ratings (D+ to F) for Overall PA and Sedentary Behaviors, yet indicators for settings (e.g., School), Family and Peers, and Government have received better grades (A− to C+).

While the Canadian Report Card has included some data on CAWD, limited efforts have been made to disaggregate the data specific to CAWD. Such an approach is needed to ensure the resulting grades and recommendations consider the unique barriers to PA that CAWD encounter and, ultimately, give effect to the participation rights of CAWD (United Nations, 2008). This report provides an overview of the Canadian Para Report Card on PA for CAWD and expert appraisal of the data gaps, opportunities, and recommendations for enhancing PA in CAWD.

Methods

Three national, representative data sets (Canadian Health Measures Survey, 2018–2019; Canadian Health Survey on Children and Youth, 2019; Health Behaviors of School-Aged Children study in Canada, 2018) and data from one national survey designed for parents of CAWD (National Physical Activity Measurement study, 2018–2020) were the primary data sources for this Canadian Para Report Card (see Supplementary Material [available online] for references to and detailed descriptions of these data sources). Table 1 provides an overview of the data sources and the factors that were considered for each data set during the grading process. These nationally generalizable or representative data sources were selected for their inclusion of (a) CAWD and (b) data related to one or more of the indicators and benchmarks of the Global Matrix 4.0 (see Ng et al., in press) and/or the Canadian Report Cards (e.g., Sleep and Physical Literacy; ParticipACTION, 2020). Table S1 (see Supplementary Material [available online]) shows indicators and their respective benchmarks that the data were graded against.

Table 1

Data Source Profiles and Alignment With Report Card Indicators

Data sourceData-collection periodSample sizeAge range (years)Disability measureMovement behavior measureData-set considerationsIndicators assessed
Canadian Health Measures Survey2018–2019 (Cycle 6)610 (with a disability)

621 (no disability)
6–17Self- or parent-reported



Mild, moderate, or severe (as per the Health Utilities Index Questionnaire)
Self-report or parent report

• Low cell count of children with severe disability (suppression of data as per the Statistics Act) for some indicators (e.g., Overall PA)

• Random selection of households
Overall PA, Active Play, Active Transportation, Sedentary Behaviors, School
Accelerometry (PA only)
Canadian Health Survey on Children and Youth20194,500 (with a disability)

47,871 (no disability)
2–17Self- or parent-reported



Any functional limitations vs. no functional limitations
Self-report or parent report• Focuses on the presence vs. absence of functional limitations (not specific impairment type)

• Bootstrap weighting used, nationally representative
Organized Sport and PA, Active Play, Sleep, Family and Peers, School, Community and Environment
Health Behaviors of School-Aged Children study in Canada20182,349 (with a disability)

19,404 (no disability)
10–16Self-reported



Intellectual disability; autism; severe vision or hearing impairment; physical disability; and mental illness; no disability
Self-report• Weighted probability technique for sampling

• Uses an administrator (school principal) questionnaire for classroom data collection
Overall PA, Organized Sport and PA, Active Play, Active Transportation, Sedentary Behaviors, School, Sleep, 24-Hour Movement Behaviors
National Physical Activity Measurement study2018–2020494 (with a disability)4–17Parent-reported



Physical, sensory, and developmental disabilities
Parent report• Sampling bias with recruitment through community (sports) programs

• Only data set intentionally focused on children and adolescents with disabilities
Overall PA, Organized Sport and PA, Active Transportation, Sedentary Behaviors, School, Family and Peers, Sleep, 24-Hr Movement Behaviors

Note. Indicators common to the Global Matrix 4.0 are in bold font. The terms used for the disability measure in the data sets are in italicized font. PA = physical activity.

Two authors (Kuzik and Arbour-Nicitopoulos) extracted and synthesized relevant data from each data source. The data synthesis was reviewed by an expert panel before the grading process. The panel included representation from parents of CAWD, community service providers, disability advisory committees, researchers with expertise in disability and movement behaviors, the Canadian Fitness and Lifestyle Research Institute (Canada’s long-standing research organization of national PA monitoring), and ParticipACTION (a nonprofit PA and thought leadership organization in Canada). Barnes et al.’s (2016) evidence-informed grading process was carried out by the panel. During two 3-hr online meetings, a team member (Kuzik) presented the data summary for each indicator’s benchmark(s) and a suggested grade, consistent with the Global Matrix 4.0 grading criteria (Ng et al., in press). Then, the panel discussed the evidence, appropriateness of the benchmark, data gaps and opportunities, and recommendations for research, practice, and policy. Where necessary, the panel revised the indicator grade until full consensus was reached. Discussions were audio-recorded to inform the supporting narrative of each grade. Grades were audited as described by Ng et al. (in press), and if a grade changed during the audit (e.g., school indicator), consensus was again reached by the panel.

Results and Discussion

Report Card Grades

Table S2 (see Supplementary Material [available online]) provides the grade and rationale for each of the 13 indicators. Eight of the indicators were assigned grades: B+ (Sleep), C+ (Organized Sport and PA), C− (Government), D (Overall PA, Sedentary Behaviors), D− (Active Transportation), and F (Active Play, 24-Hr Movement Behaviors). Insufficient national data were available to grade Physical Fitness, Physical Literacy, Family and Peers, and Community and Environment.

Measurement Gaps for CAWD

The PA measurement in CAWD poses many challenges given the diverse movement patterns, communication styles, and levels of cognition of this population. Apart from the Overall PA indicator, the evidence used to grade the indicators was limited to child and parent report measures. For Overall PA, accelerometer data from the Canadian Health Measures Survey were used, in addition to parent and child report data, to determine the proportion of CAWD meeting the benchmark of an average of 60 min of moderate-to-vigorous PA each day. Based on the Global Matrix grading guidelines, data sources that include device-based measures are more strongly weighted than self-report data in the overall indicator grade. Yet, the lack of validity for accelerometry as a measure of PA in persons with mobility impairments (Martin Ginis et al., 2021), and no representation of children with severe disabilities in the data set, resulted in the panel downgrading this indicator to a D. The panel recommended that greater consideration be given to the balanced representation and weighting of multiple data collection methods in the grading of indicators to reliably assess PA participation of CAWD. Prioritizing one method as the “gold standard” measure of a benchmark risks providing a limited and biased representation of PA participation in CAWD.

The lack of attention to quality of participation was another measurement concern. The panel noted that the Global Matrix benchmarks are simply the number of CAWD who participate (e.g., benchmark for Organized Sport and PA is percentage of CAWD who participate in programs). But for CAWD, simply being there is not the same as the United Nations’ (2008) protected right of full and effective participation. Simply counting participants may allow for easy international comparison of grades, but it does not provide a complete picture of the extent and quality of participation for CAWD. Taking a quality measurement approach to PA participation within the benchmarks would mean not only considering whether CAWD are “present” but also whether they feel satisfied, are having fun in the activities, and achieving meaningful outcomes from their involvement in the program (Evans et al., 2018).

A final measurement consideration relates to the data and benchmarks of Family and Peers. After much discussion of the evidence, a grade of incomplete (INC) was given to this indicator. The available data suggest that parents of CAWD do not appear to be supportive of their child’s PA (score low on facilitating PA and sport opportunities, meeting the PA guidelines, and being active with their child). It was noted by the panel that the existing instruments used to assess parental support for PA among CAWD are based on research in families of children and adolescents without disabilities and therefore are not contextualized within the many PA barriers (e.g., staff training, facility accessibility; Martin Ginis et al., 2016), and labor-intensive ways (Goodwin & Ebert, 2018), that parents of CAWD must navigate to support their child’s PA. Parents of CAWD are often gatekeepers of their child’s PA; they may spend countless hours searching for a suitable PA program for their child, cofacilitating staff and peer interactions, and, at times, take on a coaching role to safeguard their child’s participation in PA programs. Parent knowledge users on the panel also shared their concerns and experiences with the lack of access to programs for their children and having to start-up a PA program to fill this programming gap. The panel highlighted the need for research that develops and validates measures that capture the labor-intensive ways in which parents of CAWD support their child’s PA.

Ableism and the Benchmarks

Several disability and PA scholars have criticized the limited, and in some cases, conflicting evidence informing (inter)national public health PA guidelines for persons with disabilities (e.g., Martin Ginis et al., 2021; Smith et al., 2021). Bearing in mind that the Global Matrix benchmarks are based on empirical evidence of PA among children and adolescents without disabilities, the panel raised several concerns of the appropriateness of some of these benchmarks for CAWD. For example, despite being called Overall PA, this indicator’s benchmark only focuses on the moderate-to-vigorous PA guideline of an average of 60 min each day, and for which limited evidence is currently available for a subgroup of CAWD (Bull et al., 2020). The panel recommended that future iterations of the Global Matrix consider light-intensity PA within the benchmark of Overall PA, or even as its own indicator. This recommendation aligns with the recently developed PA guidelines in the United Kingdom for CAWD, for which CAWD expressed how activity intensity was “an unnecessary, irrelevant, and confusing” message to communicate (Department of Health & Social Care, 2022). Consistent with this work, the panel called for the prioritization of research to establish the dose–response relationship between movement behaviors (PA, sedentary, and sleep), active play, and health outcomes, based on different impairment types and severities. With this evidence, guidelines must be created that are customized for CAWD rather than a one-size-fits-all approach that is currently taken in research and practice (Bull et al., 2020). Without this evidence base and population-specific guidelines, we cannot confidently say that existing benchmarks of the Global Matrix are appropriate for CAWD.

The language used within some of the benchmarks was another example of ableism (i.e., belief of the superiority of typical abilities; Smith et al., 2021) identified by the panel. In many instances, the benchmarks indirectly suggest a notion of there being only one way for children and adolescents to be physically active or healthy. The most striking example is illustrated in the benchmarks of Physical Fitness. In the Global Matrix 4.0, the terms criterion-referenced standards and age- and sex-specific international normative data are used as the basis for grading children and adolescents on their cardiorespiratory fitness, muscular endurance, and flexibility. While Ng et al. (in press) attempted to reduce the focus of the Physical Fitness benchmarks on age- and sex-specific standards, the revised benchmark still refers to comparisons with European normative values for children and adolescents. A more representative illustration of CAWD’s levels of physical fitness, as well as their PA, requires greater investment from researchers and practitioners in developing reliable and valid instruments for use across impairment types and benchmarks that focus on individual progress versus making comparisons with values or standards that fail to account for the many ways CAWD move, learn, and play.

Better Surveillance of PA in Canadian CAWD

For the School and Community and Environment indicators, a lack of surveillance data on inclusive resources and infrastructure to support PA participation of CAWD compromised grading most of the respective benchmarks. Representative and adequately statistically powered population-level data for diverse impairment types are needed within existing Canadian PA monitoring and surveillance systems (Martin Ginis et al., 2021). These systems must consider access and quality of the school (including physical education) and community settings, and the disability/inclusion training of professionals (e.g., teachers and sport coaches). During panel discussions, the Canadian Fitness and Lifestyle Research Institute’s efforts were noted to surveille accessibility in schools. In March 2022, survey items on disability inclusion policies and the provision of adapted infrastructure in schools were added to the organization’s setting-based studies. These data will assist in future grading of the school indicator. Crowdsourcing data from mobile applications (e.g., Access Now and Jooay) and organization audit tools (e.g., The Blueprint for Quality Participation; Evans et al., 2018) were other opportunities identified by the panel for future collection of surveillance data on accessibility and user experience of community facilities and spaces.

Prioritizing the PA of Canadian CAWD in Policies and Funding

A review of the existing provincial and federal accessibility acts showed a limited focus on actions specific or relevant to PA in these policies. For example, as part of its built environment standard, the Accessibility for Ontarians Disability Act has accessibility requirements for outdoor play spaces. The lack of reference to funding to support actions toward PA for CAWD within the reviewed accessibility policies was an identified policy gap. In relation to sport policy, the current renewal of the 2012 Canadian Sport Policy was recognized by the panel as an opportunity for greater government investment in quality sport programming (including coach training) and funding to support participation among CAWD across all levels of the Canadian sport system.

Similarly, while the federal budget for 2021–2026 pledged $80M to remove barriers to local organized sports programs that are “accessible to all” and $400M to build new and expanded networks of pathways, bike lanes, trails, and pedestrian bridges, there is no specific allocation of these funds for CAWD. Additionally, the federal budget allocated $503.3M to support a more equal Canada for persons with disabilities through the creation of several strategies and benefits programs, yet there is no specific mention of PA within these federal funding commitments. Meanwhile, the panel acknowledged funding leadership from nongovernment organizations, such as the 5-year commitment of $50M from Canadian Tire Jumpstart Charities toward inclusive infrastructure (playgrounds and multisport courts) and programming opportunities for CAWD in sport and play. Policy action frameworks and dedicated government budgets were identified priorities by the panel to ensure the rights to full and effective participation in PA at school and in the community among CAWD in Canada.

Conclusion

This Canadian Para Report Card is a first step to address the limited representation of CAWD in national PA reporting, surveillance, and policy. With five of the 13 indicators graded as INC, many gaps must be addressed to provide a holistic picture of PA and its sources of influence for CAWD in Canada. Several recommendations were made to enhance research, surveillance, and policy for PA among CAWD, including the use of reliable and valid instruments for measuring the capabilities of CAWD, incorporating quality of PA participation in measurement and benchmarks, avoiding ableist language and standards in benchmarks, and prioritizing funding and policies to make PA accessible and inclusive for CAWD.

Acknowledgments

This research was supported by a Partnership Grant from the Social Sciences and Humanities Research Council of Canada (Grant no. 895-2013-1021) for the Canadian Disability Participation Project (www.cdpp.com), the Canadian Tire Jumpstart Charities, and ParticipACTION. The authors would like to thank the external reviewers of the grades that informed this Report Card.

References

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Supplementary Materials

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  • Barnes, J.D., Cameron, C., Carson, V., Chaput, J.-P., Faulkner, G.E., Janson, K., Janssen, I., Kramers, R., LeBlanc, A.G., Spence, J.C., & Tremblay, M.S. (2016). Results from Canada’s 2016 ParticipACTION report card on physical activity for children. Journal of Physical Activity and Health, 13(Suppl. 2), S110S116. https://doi.org/10.1123/jpah.2016-0300

    • PubMed
    • Search Google Scholar
    • Export Citation
  • Bull, F.C., Al-Ansari, S.S., Biddle, S., Borodulin, K., Buman, M.P., Cardon, G., Carty, C., Chaput, J.-P., Chastin, S., Chou, R., Dempsey, P.C., DiPietro, L., Ekelund, U., Firth, J., Friedenreich, C.M., Garcia, L., Gichu, M., Jago, R., Katzmarzyk, P.T., ... Willumsen, J.F. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine, 54(24), 14511462. https://doi.org/10.1136/bjsports-2020-102955

    • PubMed
    • Search Google Scholar
    • Export Citation
  • Canadian Parks and Recreation Association/Interprovincial Sport and Recreation Council. (2015, February). A framework for recreation in Canada–2015: Pathways to wellbeing. https://cpra.ca/wp-content/uploads/2021/04/FrameworkForRecreationInCanada-2016wcitation.pdf

    • Search Google Scholar
    • Export Citation
  • Department of Health & Social Care. (2022, April). UK Chief Medical Officers’ physical activity guidelines for disabled children and disabled young people: Methodology. GOV.UK. https://www.gov.uk/government/publications/physical-activity-guidelines-for-disabled-children-and-disabled-young-people-methodology/uk-chief-medical-officers-physical-activity-guidelines-for-disabled-children-and-disabled-young-people-methodology

    • Search Google Scholar
    • Export Citation
  • Evans, M.B., Shirazipour, C.H., Allan, V., Zanhour, M., Sweet, S.N., Martin Ginis, K.A., & Latimer-Cheung, A.E. (2018). Integrating insights from the parasport community to understand optimal experiences: The Quality Parasport Participation Framework. Psychology of Sport and Exercise, 37, 7990. https://doi.org/10.1016/j.psychsport.2018.04.009

    • Search Google Scholar
    • Export Citation
  • Goodwin, D.L., & Ebert, A. (2018). Physical activity for disabled youth: Hidden parental labour. Adapted Physical Activity Quarterly, 35(4), 342360. https://doi.org/10.1123/apaq.2017-0110

    • PubMed
    • Search Google Scholar
    • Export Citation
  • Martin Ginis, K.A., Ma, J.K., Latimer-Cheung, A.E., & Rimmer, J.H. (2016). A systematic review of review articles addressing factors related to physical activity participation among children and adults with physical disabilities. Health Psychology Review, 10(4), 478494. https://doi.org/10.1080/17437199.2016.1198240

    • PubMed
    • Search Google Scholar
    • Export Citation
  • Martin Ginis, K.A., van der Ploeg, H.P., Foster, C., Lai, B., McBride, C.B., Ng, K., Pratt, M., Shirazipour, C.H., Smith, B., Vasquéz, P.M., & Heath, G.W. (2021). Participation of people living with disabilities in physical activity: A global perspective. Lancet, 398, 443455. https://doi.org/10.1016/S0140-6736(21)01164-8

    • PubMed
    • Search Google Scholar
    • Export Citation
  • Minister of Justice. (2022, June). Accessible Canada Act. Government of Canada. https://laws-lois.justice.gc.ca/PDF/A-0.6.pdf

  • Murphy, N., & Carbone, P.M. (2008). Promoting the participation of children with disabilities in sports, recreation, and physical activities. Pediatrics, 121(5), 10571061. https://doi.org/10.1542/peds.2008-0566

    • PubMed
    • Search Google Scholar
    • Export Citation
  • Ng, K., Sit, C., Arbour-Nicitopoulos, K.P., Aubert, S., Stanish, H., Hutzler, Y., Augusto Santos Silva, D.A., Kang, M.-G., Francisco Lopez-Gil, J., Young Lee, E., Asunta, P., Pozeriene, J., Kazimierz Urbanski, P., Aguilar Farias, N., Wilson, O.W.A., & Reilly, J. (In press). A Global Matrix of Para Report Cards for children and adolescents with disabilities. Adapted Physical Activity Quarterly.

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