Adapted Physical Activity Policies for Children and Adolescents in Brazil: Extension of the Para Report Card Brazil

in Adapted Physical Activity Quarterly

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Diego Augusto Santos SilvaSports Center, Federal University of Santa Catarina, Florianópolis, SC, Brazil
Faculty of Health Sciences, Universidad Autónoma de Chile, Providencia, Chile

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Carolina Fernandes da SilvaSports Center, Federal University of Santa Catarina, Florianópolis, SC, Brazil

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Brazil is a country member of the Para Report Card, and Brazilian researchers have frequently published information on physical activity of children and adolescents. The current study aimed to analyze the policies for the promotion of adapted physical activity to Brazilian children and adolescents with disabilities. Official government information on adapted physical activity was analyzed from the official websites. Policies were analyzed based on the Para Report Card benchmarks, and after that we used the principles of SWOT (strengths, weaknesses, opportunities, and threats) to analyze the information. Adapted physical activity is not the main focus of any of the many policies to promote physical activity for children and adolescents. Based on the Para Report Card initiative, the score for this indicator in Brazil is D. Brazil needs to develop specific policies to promote physical activity adapted to the pediatric population with disabilities.

In 2020, the World Health Organization released guidelines for physical activity for different age groups (Bull et al., 2020). This document was developed based on the best evidence on the topic and for the first time proposed physical activity recommendations for people with disabilities (Carty et al., 2021). The current recommendation for children and adolescents with disabilities is to engage, on average, for at least 60 min per day of moderate to vigorous physical activity, most of it aerobic (Carty et al., 2021).

For children and adolescents to reach the recommended levels of physical activity, a joint action involving different actors in the process of promoting physical activity is needed (Rutter et al., 2019). In this sense, the socioecological model of promoting physical activity is highlighted because it recognizes that there are several factors at various levels of influence (e.g., interpersonal, institutional, social) that act and interact to shape behavior (Spence & Lee, 2003). One of these factors is the Government, which can be understood as the development of actions and policies to promote physical activity in a given context and to a given population subgroup that creates structural and contextual conditions for the promotion of physical activity (Bull et al., 2015; Ward et al., 2021). Thus, the study of this factor is a condition for understanding both the current levels of physical activity of children and adolescents with disabilities, as well as for understanding possible projections on this behavior. The aim of this study is to analyze policies proposed for the promotion of physical activity adapted to Brazilian children and adolescents with disabilities.

Method

This research is part of the Global Matrix on Para Report Cards of physical activity of children and adolescents with disabilities (Ng et al., 2022), and it is a parallel study to the Active Healthy Kids Global Alliance Global Matrix (version 4.0; Aubert et al., 2022). Researchers in Brazil have participated in earlier editions of the Global Matrix in 2016 and 2018, although this is the first time information on physical activity of children and adolescents with disabilities are reported using the same methodology as the Global Matrix project.

A group of experts met to gather the best evidence on all 10 main indicators of the Global Matrix project (overall physical activity, organized sport and physical activity, active play, active transportation, sedentary behavior, physical fitness, family and peers, school, community and environment, and government). The benchmark for each of the indicators is reported elsewhere in this special issue and in the Global Matrix (version 4.0; Ng et al., 2022). The complete results of all these indicators for the Brazil can be accessed in Supplementary Material S1 (available online).

In this article, we chose to detail the information from the Government indicator because since 2009, when Rio de Janeiro was chosen to host the 2016 Olympic and Paralympic Games and several government actions have been developed to promote sport in the community. In addition, of the 10 main indicators analyzed, six had insufficient evidence to assign a grade.

To obtain information on the physical activity programs/actions for children and adolescents with disabilities in Brazil, the following strategies were considered: (a) to review previous reports of the Report Card Brazil project published on the Active Healthy Kids Global Alliance website (https://www.activehealthykids.org/), (b) to review scientific articles on the Report Card Brazil project that were published in the Journal of Physical Activity and Health (Nardo et al., 2016; Silva et al., 2018), and (c) review scientific articles on the Report Card Brazil project published in the Brazilian Journal of Kinanthropometry and Human Performance (original title in Portuguese: Revista Brasileira de Cineantropometria e Desempenho Humano; Lima et al., 2021; Silva & Tremblay, 2018).

In addition to these strategies, which correspond to the literature already produced by the Report Card Brazil project, the strategy of visiting all official websites of federal government agencies in Brazil was adopted to analyze all programs and actions at national level, currently in the country. In December 2021, Brazil had 18 ministries, two secretariats (linked to ministries), and three agencies equivalent to ministries. All these 23 official websites of the Brazilian federal government were visited in December 2021, January 2022, and February 2022 to obtain information about programs/actions of physical activity adapted for children and adolescents with disabilities.

There are two benchmarks for the Government indicator in the Para Report Cards (Ng et al., 2022) and Global Matrix (version 4.0; Aubert et al., 2022): (a) evidence of leadership and commitment in providing physical activity opportunities for children and adolescents and (b) allocated funds and resources for the implementation of physical activity promotion strategies and initiatives for children and adolescents. To analyze the benchmarks, the present study used the Health Enhancing Physical Activity Policy Audit Tool (version 2; Bull et al., 2015), developed by the national approaches working group of the World Health Organization Health Enhancing Physical Activity Europe network that provided a framework covering all policy domains informed by the report card. This analysis tool was adapted to the Global Matrix (version 4.0; Ward et al., 2021) and allowed the determination of an assessment score for the different domains. After summing up a score, a grade ranging from A+ to F in descending order of quality was assigned, according to recommendations of the Global Matrix project (Aubert et al., 2018).

The present study also analyzed the Strengths, Weaknesses, Opportunities, and Threats (SWOT) of programs/actions to promote adapted physical activity for children and adolescents in Brazil. The SWOT strategy is used in the planning, analysis, and evaluation of government policies and actions in different areas of knowledge and allows the synthesis of different internal (Strengths and Weaknesses) and external (Opportunities and Threats) aspects that affect government policies (Giusti et al., 2020), serving as an instrument for reflection, reformulation, and application of these actions. More details of how the SWOT strategies were used can be found from another article in this special issue (Hutzler et al, in press). After reading all the policies/actions found in the present study, the experts from Brazil involved in the process highlighted and reached a consensus on all points of the SWOT strategy described in this article.

Results

There are six programs/actions in Brazil that in some instance promote physical activity for children and adolescents with disabilities. Only one of them is exclusively intended for children and adolescents with disabilities, the others include both young people with and without disabilities. Most of these programs/actions aim at promoting sport as agent of social transformation (Supplementary Material S2 [available online]).

According to the SWOT analysis, 11 characteristics were considered as strengths (positive points) of these actions were highlighted. On the other hand, 12 weaknesses (negative points) of these programs/actions were also highlighted. Regarding external aspects (opportunities and threats), seven opportunities that can help in the development of these programs/actions were described. On the other hand, nine threats that can negatively affect programs/actions in Brazil were also mentioned (Table 1).

Table 1

Analysis of Strengths, Weaknesses, Opportunities, and Threats (SWOT) of Programs/Actions to Promote Adapted Physical Activity for Children and Adolescents in Brazil

StrengthsWeaknesses
• Practice of organized sports for children and adolescents with disabilities

• Promotion of physical activity, even in a secondary way

• Program/action in Brazil for almost 20 years

• Use of adapted sport as agent of social transformation

• Democratize access to the practice and culture of adapted sports

• Actions available for the entire population

• Users do not pay to participate of the actions

• Availability of qualified personnel to supervise actions

• Provision of physical infrastructure for the development of actions

• Supply of didactic material for the development of actions

• Involvement of several Brazilian government ministries
• Absence of at least one program/action with main focus on promoting adapted physical activity

• National bureaucratization for the implementation of programs/actions

• Lack of detailed information on how each program/action is implemented for children and adolescents with disabilities

• Difficulty in defining regionalized goals

• Lack of information on what types of disabilities are covered by each program/action

• Brazil has many municipalities to be involved (∼5,000 municipalities)

• Absence of studies on the impact of programs/actions

• Absence of studies on the evaluation of programs/actions

• Absence of studies on the effectiveness of programs/actions

• Absence of information about the investment in each program/action

• Lack of information on the number of people benefited from each of the programs/actions

• Absence of information on the number of children and adolescents with disabilities reached in each program/action
OpportunitiesThreats
• Several actions to promote adapted physical activity can be carried out in the school environment

• Several actions to promote adapted physical activity can be carried out in the neighborhood

• Several actions to promote adapted physical activity can be carried out with the support of friends and family

• Great interest of the population in accessing programs/actions because actions have no financial costs

• Brazil has tradition of practicing sports in the school environment and outside the school

• The 2021 launch of the Physical Activity Guide for the Brazilian population

• The COVID-19 pandemic demonstrated the need for a regular practice of physical activity in all age groups
• The theme adapted physical activity has little evidence in the media

• Absence of specific public policy for the promotion of adapted physical activity in Brazil

• Absence of the theme adapted physical activity in the permanent agenda of the federal government

• Absence of dialogue between universities and strategic sectors of the federal government

• Decreased financial resources for scientific research

• Increased political and social tensions in Brazil

• Increase in social and regional inequalities in Brazil

• Lack of transparency in the allocation of financial resources for the implementation of programs/actions

• Global uncertainty in the face of the COVID-19 pandemic

The overall score of Brazil for programs/actions to promote physical activity in children and adolescents with disabilities was 32 (of a total of 100), which equates to Brazil as having a D grade. The most negative aspects of these programs/actions were those of the dimensions “Identifiable reporting structures,” “Identified funding/resourcing (national programs),” and “Monitoring and evaluation plan.” On the other hand, these programs/actions stood out positively in the “Identified accountable organization(s)” dimension (Supplementary Material S3 [available online]).

Discussion

Brazil presented programs/actions to promote sport for children and adolescents with disabilities and this demonstrates that the theme of sport in Brazil is also aimed at children and adolescents with disabilities. One of the reasons for this is that in the Federal Constitution of Brazil and in the Statute of Children and Adolescents of Brazil, the right to play, sport, and leisure is guaranteed (UNICEF, 2022), so these actions are Government policies. The “Segundo Tempo” program has been in operation for almost 20 years and is a result of the Brazilian government policy to promote after school hours sports. Information about the investment of the actions for children and adolescents with disabilities was not found in the researched material. The lack of information on investments aimed at these programs/actions makes it difficult to assess the effectiveness and efficiency of these government strategies (Bull et al., 2015). The theme of promoting physical activity comes in second place in current programs/actions in Brazil. The lack of a specific program to promote physical activity for children and adolescents with disabilities based on theoretical and methodological aspects of health promotion may be one of the reasons why there are no studies at the national level to estimate the prevalence of physical activity in children and adolescents with disabilities in Brazil. Furthermore, the creation of programs/actions to promote physical activity for children and adolescents with disabilities in Brazil should be a governmental strategy that involves not only schools, but also the neighborhood, the community, family, and friends.

The COVID-19 pandemic is seen as one of the opportunities to promote physical activity in children and adolescents with disabilities (Yelizarova et al., 2022). The population of children and adolescents with disabilities already suffers from social stigma of discrimination and lack of opportunities as a result of the disability (Martin Ginis et al., 2021) and with the pandemic situation, many sectors that these young people attended were closed for a long time (schools and leisure spaces; UNICEF, 2021). Physical activity can help in coping with situations related to anxiety, stress, and also for the social reintegration of this population in a post-pandemic period.

For the registration of a country to host the Olympic and Paralympic Games, the national Olympic and Paralympic confederation must submit a proposal that meets the evaluation criteria of the International Olympic Committee, namely: political and social support, general infrastructure, competition venues, Olympic village, environment, accommodations, transport, security, past experiences, finances, and general project and legacy. In the case of Brazil, in 2009 Rio de Janeiro was elected the host city of the 2016 Olympic and Paralympic Games, initiating the elaboration of many actions around the country. Because of the games in 2009, the Brazilian government launched the Olympic Legacies Plan (Brasil, 2009), with planning of the possible impacts to be achieved by the games in Brazil in relation to educational, participation, and performance sports. Among these, during the Olympic and Paralympic cycle, the main legislation that governs people with disabilities in Brazil was introduced, with items that specifically deal with sport and leisure—Statute of Persons with Disabilities (Law No. 13,146, on July 6, 2015; Brasil, 2015). Among other things, this Law determines that in the school system it is the responsibility of the Brazilian government to ensure, create, develop, implement, encourage, monitor and evaluate the access of people with disabilities, on equal terms, to games and recreational, sports, and leisure activities. This would provide children and adolescents who attend school with access to physical activities in the school environment. The development of this legislation is considered the greatest Paralympic legacy in the country (Brasil, 2015). Another article of the Para Report Card project provides more details on policies developed in different countries, including Brazil (Sit et al., in press).

This research has many limitations. First, there is the fact that it has not analyzed state and/or municipal programs/actions to promote physical activity. Brazil has more than 5,000 municipalities and an analysis of this nature would take a long time. The analysis of the present study was a rapid evaluation. On the other hand, the analysis of federal programs/actions allows having an overview of how the Brazilian government understands the problem of physical activity in children and adolescents with disabilities. Another limitation of this research is that the SWOT analysis (Giusti et al., 2020) is based on the readings of research members regarding the policies/actions found, and since it is a subjective analysis, it is subject to information bias. However, this research also used the tool recommended by the WHO (Bull et al., 2015) for the analysis of public policies aimed the promotion of physical activity, which allowed the finding that Brazil is at low to moderate classification (Grade D) in the Government indicator of the Para Report Card.

It could be concluded that Brazil has six programs/actions at the federal level that in some instance promote physical activity for children and adolescents with disabilities. Such programs/actions are not based on theoretical and methodological aspects of health promotion, which limits their scope for this topic of physical activity. In addition, Brazil needs to evaluate the effectiveness and efficiency of current programs/actions so that the population is aware of what has been proposed as a Government policy.

References

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    • Search Google Scholar
    • Export Citation
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  • Aubert, S., Barnes, J.D., Demchenko, I, Hawthorne, M., Abdeta, C., Nader, P.A., Sala, J.C.A., Aguilar-Farias, N., Aznar, S., Bakalár, P., Bhawra, J., Brazo-Sayavera, J., Bringas, M., Cagas, J.Y., Carlin, A., Chang, C.-K., Chen, B., Christiansen, L.B., Christie, C.J., . . . Tremblay, M.S. (2022). Global Matrix 4.0 Physical Activity Report Card grades for children and adolescents: Results and analyses from 57 countries. Journal of Physical Activity and Health, 19(11), 700728. https://doi.org/10.1123/jpah.2022-0456

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Aubert, S., Barnes, J.D., Abdeta, C., Abi Nader, P., Adeniyi, A.F., Aguilar-Farias, N., . . . Tremblay, M.S. (2018). Global Matrix 3.0 Physical Activity Report Card grades for children and youth: Results and analysis from 49 countries. Journal of Physical Activity and Health, 15(Suppl. 2), 251273. https://doi.org/10.1123/jpah.2018-0472

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Brasil. (2009). Caderno de Legado Social. Ministério do Esporte. http://www.esporte.gov.br/arquivos/rio2016/cadernoLegadosSocial.pdf

  • Brasil. (2015). Congresso. Senado. Constituição. Lei n° 13.146, de 6 de julho de 2015. Institui a Lei Brasileira de Inclusão da Pessoa com Deficiência (Estatuto da Pessoa Com Deficiência). http://www.planalto.gov.br/ccivil_03/_ato2015-2018/2015/lei/l13146.htm

    • Search Google Scholar
    • Export Citation
  • Bull, F., Milton, K. and Kahlmeier, S. (2015). Health-enhancing physical activity (HEPA) policy audit tool (PAT)—Version 2. WHO Regional Office for Europe.

    • Search Google Scholar
    • Export Citation
  • Bull, F.C., Al-Ansari, S.S., Biddle, S., Borodulin, K., Buman, M.P., Cardon, G., . . . 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

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Carty, C., van der Ploeg, H.P., Biddle, S.J.H., Bull, F., Willumsen, J., Lee, L., Kamenov, K., & Milton, K. (2021). The first global physical activity and sedentary behavior guidelines for people living with disability. Journal of Physical Activity and Health, 18(1), 8693. https://doi.org/10.1123/jpah.2020-0629

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Giusti, A., Maggini, M., & Colaceci, S. (2020). The burden of chronic diseases across Europe: What policies and programs to address diabetes? A SWOT analysis. Health Research Policy and Systems, 18(1), 12. https://doi.org/10.1186/s12961-019-0523-1

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hutzler, Y., Barak, S., Aubert, S., Arbour-Nicitopoulos, K.P., Tesler, R., Sit, C., & Ng, K. (in press). A SWOT-oriented synthesis of the Global Matrix Para Report Card on physical activity of children and adolescents with disabilities. Adapted Physical Activity Quarterly.

    • Search Google Scholar
    • Export Citation
  • Lima, T.R., Martins, P.C., Alves Junior, C.A.S., Moraes, M.S., Zanlorenci, S., Borges, L.L., . . . Silva, D.A.S. (2021). Report Card Brazil: Systematic review of muscle strength assessment in children and adolescents in Brazil. Revista Brasileira de Cineantropometria e Desempenho Humano, 23, e80292. https://doi.org/10.1590/1980-0037.2021v23e80292

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Martin Ginis, K.A., van der Ploeg, H.P., Foster, C., Lai, B., McBride, C.B., Ng, K., . . . Heath, G.W. (2021). Participation of people living with disabilities in physical activity: A global perspective. The Lancet, 398(10298), 443455. https://doi.org/10.1016/S0140-6736(21)01164-8

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Nardo, N., Jr., Silva, D.A.S., Ferrari, G.L., Petroski, E.L., Pacheco, R.L., Martins, P.C., . . . Matsudo, V. (2016). Results from Brazil’s 2016 report card on physical activity for children and youth. Journal of Physical Activity and Health, 13(S2), 104109. https://doi.org/10.1123/jpah.2016-0398

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ng, K., Healy, S., O’Brien, W., Rodriguez, L., Murphy, M., & Carlin, A. (2022). Irish Para Report Card on physical activity of children and adolescents with disabilities. Adapted Physical Activity Quarterly. Advance online publication. https://doi.org/10.1123/apaq.2022-0074

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rutter, H., Cavill, N., Bauman, A., Bull, F. (2019). Systems approaches to global and national physical activity plans. Bulletin of the World Health Organization, 97(2), 162165. https://doi.org/10.2471/BLT.18.220533

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Silva, D.A.S., Christofaro, D.G.D., Ferrari, G.L., Silva, K.S., Nardo Júnior, N., Silva, R.J., . . . Barbosa Filho, V.C. (2018). Results from Brazil’s 2018 report card on physical activity for children and youth. Journal of Physical Activity and Health, 15(Suppl. 2), 323325. https://doi.org/10.1123/jpah.2018-0421

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Silva, D.A.S., & Tremblay, M.S. (2018). It’s time to take care of Brazilian children and adolescents. Revista Brasileira de Cineantropometria e Desempenho Humano, 20(4), 363366. https://doi.org/10.5007/1980-0037.2018v20n4p363

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sit, C., et al. (in press). A global perspective of policies for promoting physical activity among children and adolescents with disabilities. Journal of Physical Activity and Health.

    • Search Google Scholar
    • Export Citation
  • Spence, J.C., & Lee, R.E. (2003). Toward a comprehensive model of physical activity. Psychology of Sport and Exercise, 4(1), 724. https://doi.org/10.1016/S1469-0292(02)00014-6

    • Crossref
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