Physical inactivity is affecting all age groups and most countries worldwide. Globally, only about one-fifth of children and adolescents meet the physical activity (PA) guidelines, with the Latin American region being one of the most affected.1 Regarding PA-related behaviors in children and adolescents, Chile has reported lower levels of PA compared with other countries and regions.1–3 Furthermore, Chile has consistently shown significant disparities in PA according to sex and family income/education levels,2,4,5 reinforcing the need to understand better the factors related to these differences to plan and invest for positive and equitable changes in PA.
Alongside the broader challenges in PA faced by various populations, it is crucial to recognize the specific disparities experienced by children and adolescents with disabilities (CAWD).6 PA benefits all children and youth by enhancing physical fitness, mental health, and nutritional status, among other factors.7 For those with disabilities, it also improves cognitive function in conditions such as attention-deficit/hyperactivity disorder and enhances physical abilities in children with intellectual disabilities.7 PA in CAWD has been found to provide enjoyment and satisfaction and improve functional skills, muscle strength, and social benefits with relatively low costs and long-lasting positive effects.8 However, research indicates that CAWD often encounter barriers that limit their participation in PA, exacerbating existing health inequalities and limiting equity and integral development, thus increasing social exclusion.9 These barriers may include inaccessible facilities, lack of adaptive equipment, and societal stigmas surrounding disability, among other aspects that limit social participation.10–12 Consequently, CAWD are at an increased risk of experiencing adverse health outcomes compared with their nondisabled peers, suggesting the necessity of implementing strategies focused on this population.13
The implications of limited PA extend beyond its immediate impact on physical mobility and fitness. CAWD may face challenges in developing fundamental motor skills or physical literacy, which are crucial for overall physical and cognitive development.6,14 Moreover, the lack of engagement in regular PA may contribute to increased sedentary behaviors,15 placing these children at a higher risk for obesity and related health issues.13 In addition, the social and emotional well-being of CAWD may be compromised as PA plays a pivotal role in fostering social interactions.16,17 These negative implications could be extended to adulthood (eg, 9 out of 10 adults with disabilities are physically inactive in Chile), presenting an alarming situation for the present and future.18
Evidence from Europe has shown that CAWD are less likely to meet PA recommendations than children and adolescents without disabilities.19 However, there is a lack of regional information about the situation of PA for CAWD in Latin America. Prior studies have predominantly addressed general policies and actions, creating a gap in comprehending the specific circumstances for CAWD.20,21 Improved monitoring and surveillance of PA levels and determinants are crucial to filling this data gap, enabling a comprehensive understanding of the prevalence, patterns, and tendencies of PA among CAWD.22,23 This, in turn, informs evidence-based interventions and provides insights into the distinct domains and correlates of PA within this population. A nuanced understanding of these factors is essential for designing tailored programs that address barriers and promote equitable opportunities for PA among CAWD in the Latin American context.
To address the dearth of data on PA in CAWD globally, an innovative initiative known as the Global Matrix of Para Report Cards (PRCs) of CAWD has been developed by researchers and experts in the field24 and represents a significant step toward filling this crucial gap for developing collective recommendations.21,25 This pioneering effort involves the participation of countries from various continents and marks the first version of these PRCs. The coordinating team of the Report Card (RC) on PA for children and adolescents in Chile decided to participate in this initiative, providing relevant information to contribute to a more nuanced and globally inclusive understanding of PA patterns among CAWD. Chile has already participated in 3 PA RC for children and adolescents,2,5,26 and this is the first version of the Chilean PRC. Unfortunately, in the previous RCs, Chile scored a very low grade and has not shown improvements in overall PA during that time frame.26 However, these RCs have provided a better understanding of PA-related behaviors and their determinants, presenting a national opportunity and challenge for improving PA. Through such collaborative endeavors, the initiative seeks to inform targeted actions and policies for promoting inclusive PA practices locally and globally. Therefore, the aim of this manuscript is to summarize the findings of the first Chilean PRC on PA for CAWD as part of the First Global Matrix of PRCs.
Methods
The Global Matrix of PRCs was developed following the experience and guidance of the Active Healthy Kids Global Alliance (AHKGA). The Global Matrix of PRCs was led by Ng et al,24 who invited research leaders of the countries or jurisdictions involved in the Global Matrix 4.01 to collate disability-specific RCs. This international effort finally congregated 14 countries or jurisdictions from different world regions.24 More details about the recruitment and development process are published elsewhere.24
Chile’s 2022 PRC included 10 core PA indicators common to the Global Matrix of PRCs: Overall Physical Activity, Organized Sport and Physical Activity Participation, Active Play, Active Transportation, Sedentary Behaviors, Physical Fitness, Family and Peers, School, Community and Environment, and Government.1,24 The indicators and benchmarks are described in included in Supplementary Materials (available online). Evidence from scientific articles, reports, and databases available or released from 2018 until January 2022 was included for each indicator. Chile’s 2022 PRC includes data from 2018, as Chile’s 2018 RC included a specific indicator called “Inclusion” that assessed previous PA-related data among CAWD.2 The Inclusion indicator also assessed data for immigrant children and children belonging to indigenous ethnic groups. The primary data sources are shown in Table 1.
Main Data Sources Used to Inform Indicators of Chile’s 2022 PRC on PA for CAWD
| Data source | Characteristics | Indicator(s) informed |
|---|---|---|
| NSPASHCY 2019 | Nationally representative; 5 to 17 years old; subsample of 275 CAWD out of 5046 | OPA, SP, AT, SB, FP, Sc, CE |
| Second NSPASHD 2020 | Nationally representative from 13 years and older; this includes a subsample of 360 CAWD out of 3832; 13 to 17 years old | OPA, SP, Sc, CE |
| NHS 2016–2017 | Nationally representative; N = 6233; 15 and older | FP |
| NSPASA 2018 | Nationally representative; N = 6025; 18 and older | FP |
| PISA 2018 | Nationally representative; 254 school principals | Sc |
| National Survey on Urban Quality of Life (ECVU 2018) | Nationally representative; for 15 years old and older; analysis was conducted only for those aged 15 to 17 years; N = 378 | CE |
| Ministry of Education | National regulations and reforms 2004, 2016, 2018, 2019 | Sc |
| Education Quality Agency | National level, census type, 98.7% of schools; 222.353 y 8 students; 5.953 schools | Sc |
| National Institute of Sports | Program information: “Crecer en movimiento,” National Fund for the Promotion of Sports | Go |
| National Disability Service | National Fund for Inclusive Projects | Go |
Abbreviations: AT, active transportation; CAWD, children and adolescents with disabilities; CE, Community and Environment; ECVU: Encuesta de Calidad de Vida Urbana; Go, Government; FP, Family and Peers; NHS, National Health Survey; NSPASA, National Survey on Physical Activity and Sports Habits in adult population; NSPASHCY, National Survey on Physical Activity and Sports Habits on children and youth 2019; NSPASHD, National Study on Physical Activity and Sports Habits on population with disabilities 2020; OPA, Overall Physical Activity; PA, physical activity; PISA, Programme for International Student Assessment; PRC, Para Report Card; SB, Sedentary Behavior; Sc, School; SP, Sport and Physical Activity Participation.
To facilitate cross-country or jurisdictional comparisons within the PRCs, disabilities were delineated according to the United Nations definition, which states “persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others.”27
A research working group (RWG) was coordinated to collect and analyze the data. The RWG comprised researchers from various Chilean universities, many of whom had been involved in earlier RC versions due to their extensive experience in PA research. New members were invited as they began collaborating with the RC team on other PA studies for CAWD in Chile. To favor comparability between countries, each country followed the process and benchmarks developed by the AHKGA (see Supplementary Table S2 in Supplementary Materials [available online]). After data extraction, the RWG assigned letter grades (A–F) based on the benchmarks. The grades were also converted into the Chilean national grading system from 1 to 7 to facilitate the interpretation and dissemination of the results (see Supplementary Table S2 in Supplementary Materials [available online]).
When some indicators had more than one benchmark, specific weights were assigned for the benchmarks depending on the relevance of the data. The grading process was cross-validated against the grade assigned by each of the members of the RWG based on the data and their expertise. A high agreement was reached between the weights and the grades provided by the RWG. The indicators that required this approach were Overall Physical Activity, Organized Sports and Physical Activity Participation, Family and Peers, School, and Community and Environment. For example, for the Overall Physical Activity and Organized Sports and Physical Participation, more weight was given to data derived from the National Study on Physical Activity and Sports Habits on Population with Disabilities 2020, as it was designed to recruit people with disabilities only,28 whereas the National Survey on Physical Activity and Sports Habits on Children and Youth 2019 was intended for all children and youth,29 including those with disabilities. As the Family and Peers indicator had data for different benchmarks, a weight of 30% was given by the RWG for benchmarks indicating doing PA with either adult family members (30%) or peers (30%). In comparison, 20% was given to those reporting the prevalence of CAWD brought by adults to sports or PA, and 20% for the benchmark indicated the percentage of adults engaging in leisure PA for 30 minutes 3 or more times per week.
The Government indicator of Chile’s RC 2022 was analyzed using a standardized tool (HEPA Policy Audit tool version 2),30 which was used to guide the grading process of Chile’s PRC. However, given the specialized nature of regulations necessary to influence PA and sports participation in CAWD and the absence of a dedicated rubric applicable to policies affecting this population, an exploration, summarization, and qualitative grading of PA policies targeting CAWD was conducted to complement the initial process for the RC. Seven jurisdictions included in the first Global Matrix of PRCs used the same tool (Brazil, Canada, Ireland, Philippines, Poland, South Korea, and Spain), whereas 5 used a qualitative approach only (Finland, France, Hong Kong SAR, Israel, and Lithuania) to grade the Government indicator. The aspects considered in this evaluation are succinctly presented in Table 1.
External auditors, including researchers familiar with the procedures of the Global Matrix 4.0 and the PRCs, provided feedback for all grades by either endorsing them or seeking additional transparency regarding evidence and rationale. In certain instances, there was a call to reconsider the assigned grades.
Results
The overall grade for Chile’s PRC was D+ (3.3 in the Chilean grading system). Eight of 10 indicators were graded as there were insufficient data for 2: Active Play and Physical Fitness. Grades ranged from F or 2 (Sedentary Behavior) to B− or 4.5 (Government). Using the Chilean grading system, only 2 indicators (School and Government) had passing grades (C, 4, or higher).
Overall Physical Activity
International Grading System: D−; Chilean Grading System: 2.5
The grade was based on the following data: (1) 5.8% of youth with disabilities (13 to 17 years old) reported being physically active for 60 minutes on at least 4 days per week according to National Study on Physical Activity and Sports Habits on Population with Disabilities 202028 and (2) the National Survey on Physical Activity and Sports Habits on Children and Youth 2019 showed that 42.2% of CAWD (5 to 17 years old) reported being physically active for 60 minutes on at least 4 days per week.29 More weight was given to data derived from the National Study on Physical Activity and Sports Habits on Population with Disabilities 2020, as it was designed to exclusively recruit people with disabilities.
Organized Sports and Physical Activity Participation
International Grading System: C−; Chilean Grading System: 3.5
The grade was based on the following indicators: (1) 48.7% of CAWD reported participation in sports activities (eg, football, basketball, dancing, athletics, others) either at school (31.8%) or after school (21.7%)29;(2) 23.7% of youth with disabilities (13 to 17 years old) reported participation in sports activities/events during leisure time28; and (3) 47% of youth reported lack of interest as the main reason for not participating in PA or sports activities.28
Active Play
International Grading System: INCOMPLETE; Chilean Grading System: INCOMPLETE
This indicator is INCOMPLETE as there were no data on the percentage of CAWD who either engaged in unstructured/unorganized active play at any intensity for more than 2 hours per day or who reported being outdoors for more than 2 hours per day. In the NSPASHCY 2019, a question regarding the number of days spent outdoors per week was included, but it does not allow for grading according to the benchmarks of the Global Matrix.
Active Transportation
International Grading System: D−; Chilean Grading System: 2.5
Based on the NSPASHCY 2019, approximately a quarter of CAWD use active modes of transportation (ie, walking) to (21.9%) or from (27.1%) school.29 There was no specific data about wheelchair use to and from school.
Sedentary Behavior
International Grading System: F; Chilean Grading System: 2
Only 19.3% of youth (13 to 17 years old) with disabilities meet the screen time recommendation within the Canadian 24-Hour Movement Guidelines for Children and Youth based on the NSPASHCY 2019.29 There were no nationally representative data for children and adolescents under 13 years of age.
Physical Fitness
International Grading System: INCOMPLETE; Chilean Grading System: INCOMPLETE
There were no nationally representative data on physical fitness for CAWD.
Family and Peers
International Grading System: D+; Chilean Grading System: 3.3
This grade was based on the following data: (1) 41.5% of CAWD reported doing PA or sports with peers. However, this percentage decreases significantly from 66.7% for 5 to 9 years old to 15.9% for those aged 13 to 17 years29; (2) 56.4% of CAWD reported playing outdoors or doing sports with an adult family member (eg, parents, grandparents, uncles/aunts, etc)29; (3) 24.5% of CAWD (10 y and older) reported that an adult transports them to do PA or sports29; and (4) overall, only 13.3%31 to 18.7%32 of adults engage in leisure PA for 30 minutes for 3 or more times per week.
School
International Grading System: C+; Chilean Grading System: 4.3
The grade was based on the following data: (1) 34.7% of CAWD reported participation in sporting activities apart from physical education at school29; (2) 73% of youth with disabilities reported participating with their classmates in physical education lessons, while 8% reported separately, and 10% do nonrelated PA28; (3) 57% of youth with disabilities reported lack of adaptation to their needs as the main reason for not participating in all physical education lessons, and 36% are asked to do passive activities28; (4) 36% of youth with disabilities reported doing PA-related activities during school breaks28; (5) 76.6% of school principals reported that they offer sport-related activities in their schools33; (6) physical education is mandatory from years 1 to 10 at least 4 pedagogic hours per week from years 1 to 4 (180 min/wk) and 2 pedagogic hours per week from years 5 to 10 (90 min/wk),34,35 but physical education is optional for students in years 11 and 1236; (7) physical education lessons taught by a specialist (ie, a physical educator) are only mandatory from years 9 to 12 of education37; (8) At national level, schools score 64 out of 100 points on average in the indicator related to promoting actions for PA in the school community within the domain of healthy lifestyle for students in year 838; and (9) Public Sport infrastructure is available for the use of all public schools (44.7% of all schools in Chile) in their respective councils.39
Community and Environment
International Grading System: D+; Chilean Grading System: 3.3
This grade was based on the following data: (1) 49.6% of youth reported good/very good quality and 47% good/very good accessibility of public infrastructure (eg, fields, skate parks, etc) specifically geared toward promoting sports practice40; (2) 9.5% of children and youth (10 y and older) reported having bike paths or skate parks nearby29; and (3) 23.4% of youth with disabilities reported participation in a community organization, and 15.6% of youth with disabilities reported participation in a sports club.28
Government
International Grading System: B−; Chilean Grading System: 4.5
(1) The program, known as “Crecer en Movimiento,” (in English Grow in Motion) features a component titled “Sports Schools for Children with Disabilities,” which is coordinated by the National Institute of Sports. Commencing in 2019, the “Crecer en Movimiento” program has integrated a module into professional training specifically focused on inclusive PA. This module provides didactic tools to effectively work with students with disabilities. The training is designed for teachers responsible for implementing the initiatives outlined in the “Crecer en Movimiento” program. (2) The “National Fund for the Promotion of Sports” (in Spanish Fondo Nacional para el Fomento del Deporte, FONDEPORTE) comprises 4 application categories: training for sports, recreational sports, competitive sports, and sports science. Within each of them, there is an opportunity to apply for funds specifically allocated for adapted and/or para-sports and for working with people with disabilities.41 (3) In 2016, Chile enacted Law 20.978, formally recognizing Adapted and Paralympic Sports. This legislation integrates adapted sports into the National Physical Activity and Sports Policy. It must ensure the rights of individuals with disabilities to physical education, sports participation, health, well-being, integration, and leisure. Emphasis is placed on the necessity for adapted and accessible facilities to fulfill these rights. (4) The National Disability Service (in Spanish: Servicio Nacional de Discapacidad, SENADIS) has a fund called the “National Fund for Inclusive Projects” that finances initiatives that contribute to or enhance the social inclusion of people with disabilities, promote their rights, support their autonomy and independence, and improve their quality of life. Among its areas of application, there is one for inclusive sport.42
Discussion
This manuscript summarizes the findings of Chile’s first PRC on PA for CAWD as part of the Global Matrix of PRCs 1.0.24 Most indicators received low grades, with an overall D+ grade. The grades ranged from F (Sedentary Behavior) to B− (Government). Two out of 10 indicators (Active Play and Physical Fitness) were graded INCOMPLETE due to insufficient data to score them.
The Government and School indicators received higher grades (B− and C+, respectively), meeting the passing criteria of C or above. These results mirrored those of Chile’s 2022 RC,26 in which Government scored A− and School scored C (Table 2). Most evaluated policies have emerged in the past decade, suggesting the need for continued observation to gauge their impact on PA behaviors. Notably, these grades reflect efforts not solely focused on promoting PA but also on broader developmental aspects for CAWD, particularly within educational contexts. Addressing barriers to PA for CAWD, such as enhancing training for physical education (PE) teachers, improving school facilities, and fostering family support, is imperative.21 The highest grade for the Government indicator compared with the others suggests a potential gap between the designed policies and their implementation. To reduce the gap in Chile, efforts should remain a high priority on national political agendas to ensure consistent and effective PA strategies outlined in current policies. Furthermore, it was beyond the scope of this study to evaluate the extent to which the designed policies were implemented or to assess the effectiveness of the implemented programs for CAWD. Additionally, due to the absence of an internationally and nationally validated rubric for monitoring PA policies for CAWD, objectively monitoring this indicator over time is not possible, and the assigned grade should be interpreted as indicative and approached with caution.
Grades Comparison Between Chile’s 2022 PRC and RC on PA
| Indicators | PRC | RC | ||
|---|---|---|---|---|
| International grading system | Chilean grading system | International grading system | Chilean grading system | |
| Overall Physical Activity | D− | 2.5 | D+ | 3.3 |
| Organized Sports and Physical Activity Participation | C− | 3.5 | C− | 3.5 |
| Active Play | INC | INC | INC | INC |
| Active Transportation | D− | 2.5 | D | 3 |
| Sedentary Behavior | F | 2 | D− | 2.5 |
| Physical Fitness | INC | INC | INC | INC |
| Family and Peers | D+ | 3.3 | D | 3 |
| School | C+ | 4.3 | C | 4 |
| Community and Environment | D+ | 3.3 | D+ | 3.3 |
| Government | B− | 4.5 | A− | 6 |
| Overall grade | D+ | 3.3 | D+ | 3.3 |
Abbreviations: INC, incomplete data; NA, not applicable as this indicator was included from the current version; PA, physical activity; PRC, Para Report Card; RC, Report Card. Note that the letter grading system was defined as follows: A is 80% to 100%; B is 60% to 79%; C is 40% to 59%; D is 20% to 39%; F is < 20%. In the Chilean numerical system, scoring under 4 denotes failure. In the case of adverse outcomes such as sedentary behavior, a reversed order of the percentages was considered for grading.
Despite improvements in PA and educational policies, positive behavioral changes have yet to be observed. The Overall Physical Activity (D−), Sedentary Behavior (F), and Active Transportation (D−) indicators scored lower compared with Chile’s RC 2022 and international data from the First PRC. This aligns with Chile’s historical trend of comparatively lower overall grades in the 3 previous Global Matrices, highlighting the urgent need for a better understanding of the root causes of the sustained negative results observed.1,2,26 Promising initiatives from countries with higher grades, such as professional development programs in Lithuania43 and the availability of PA programs and sports clubs in schools like in France,44 may be adapted to the Chilean context to improve the opportunities for PA for CAWD.24
Social and physical environments are key elements in providing a positive platform for PA engagement by providing access opportunities and facilitating the process of maintaining active behaviors. Unfortunately, Family and Peers (D+) and Community and Environment (D+) received failing grades, aligning with the grades reported in Chile’s RC 2022 (Table 2). This highlights the need for strategies and investments to enhance structural support through improved and inclusive access to facilities for active living.45 These actions should extend beyond CAWD to include parents, for instance, by improving active transportation infrastructure or regulations and actions that focus on providing time availability and support to CAWD carers and families. Implementing continuous, pertinent, and effective social marketing campaigns can effectively convey messages promoting PA across all age groups.
Over the past decade, Chile has actively developed policies such as the Adapted and Paralympic Sports Law46 and has made investments to promote para-sports, which were integrated into the National Physical Activity and Sports Policy of the Ministry of Sports.47 The low grade (C−) for the Organized Sports and Physical Activity Participation indicator was also consistent with the same indicator in the Chilean RC 2022. National efforts should prioritize the provision of inclusive accessibility and diverse opportunities for CAWD, emphasizing PA and sports participation across various developmental stages and skill proficiencies rather than focusing on talent detection and selection for para-sports at competitive high performance.
Future Steps
Research into PA among CAWD is often less prioritized than studies conducted on PA in the general population. This is evidenced by the less representative samples, lower statistical power for population-level data, and limited stratification of data for various disabilities. Additionally, most data on PA among CAWD have been collected in countries from the global north, limiting the exchange of lessons learned from other regions of the world. Regional collaborations should be strengthened to organize researchers from other countries to participate in future versions of the Global Matrix of PRC. Despite recent improvements in monitoring in Chile, which have facilitated the development of the current PRC, future surveys should expand their scope to assess PA-related indicators and increase the samples and representativeness of CAWD.
Addressing disparities in PA for CAWD requires a comprehensive and inclusive approach.25 Efforts should focus on creating accessible environments to foster adaptive sports, recreational activities, and a culture of inclusivity, in addition to increasing individual opportunities and access. The recently released Global Report on Children with developmental disabilities by the World Health Organization6 can be directly connected and used as background for the promotion of PA in CAWD. Among other actions, the report calls for specific actions that can help improve future grades of the PRC, such as strengthening multisectoral policymaking to address inequities in health outcomes; addressing stigmatization; fostering inclusive enabling environments; and strengthening data, monitoring, and research.6 Recommendations for improving the indicators of Chile’s 2022 PRC on PA for CAWD in the future are shown in Table 3.
Recommendations for Improving the Indicators of Chile’s 2022 PRC on PA for CAWD
| Indicators | Recommendations |
|---|---|
| Overall Physical Activity | To integrate PA into all policies across different sectors, emphasizing its importance in education, well-being, social and built environments, and other settings. For example, reinforce PA as a way for promoting inclusion, academic performance, and good climate at schools. To implement and regularly assess the National PA Policy process and impact to ensure effectiveness in promoting PA for all demographics, particularly focusing on populations with high support needs. To promote research-based strategies tailored to the population with disabilities, employing inclusive messaging and avoiding ableist language. This could start with the development of national PA guidelines for CAWD, a social marketing campaign for promoting PA in CAWD, and the refinement of current national surveys to capture PA-related indicators in CAWD. |
| Organized Sports and Physical Activity Participation | To implement engaging and inclusive programs within relevant stakeholders (eg, schools and clubs) clubs to address the lack of interest barrier. This includes investing in organized sports activities, providing financial support for equipment, and training professionals to lead and guide individuals with disabilities. To strengthen organized sports in schools by allocating funds and efforts to expand extracurricular activities. This involves not only financial resources for purchasing materials and equipment but also the training of professionals responsible for leading, guiding, and training individuals with disabilities. To focus on diversifying the range of sports practiced, increasing levels of PA, and, particularly in the early school years, prioritize the development of motor and social skills through sports rather than emphasizing competition. |
| Active Play | To align future survey questions with global benchmarks to establish a comprehensive grading system for Active Play. To ensure the right to play through collaborative efforts involving local governments, neighborhood associations, and other community organizations. Active playing can be included in ways of promoting learning at schools. To prioritize the development of inclusive spaces and programs for free playing in open areas (eg, open streets), including play infrastructure for CAWD. Additionally, to regulate the availability of spaces for active playing at schools and to facilitate the use of sport-like uniforms rather than formal uniforms. |
| Active Transportation | To design interventions to act in specific barriers to facilitate active transportation of parents and CAWD by: • Expanding and maintaining accessible routes, including proper curb ramps and sufficient sidewalk space. • Strengthening accessible public transportation to promote a combination of public and active transportation over car usage. To strengthen inspection and enforcement of the new road coexistence law in Chile to ensure safer conditions for pedestrians, cyclists, and CAWD. To implement programs at schools to facilitate active transportation, including education and infrastructure support. Additionally, enhance and expand bike path networks to and from schools to encourage safer and more accessible routes for active commuting. For example, community-based and participatory programs can be implemented for increasing awareness and improving accessibility in school surroundings. |
| Sedentary Behavior | To fill data gaps regarding sedentary behavior among CAWD under 13 in future national surveys. To encourage less screen time for CAWD by: • Striving to balance/reduce the use of screens for educational or entertainment purposes at schools and homes. • Incorporating more strategies to reduce screen time, especially at home, with an emphasis on the role of parents and caregivers. To implement a comprehensive social marketing campaign to address screen use in all settings, including: • Educate and provide tools to caregivers to address problematic screen use in CAWD. • Offering a variety of inclusive physical activities in localities (neighborhoods, communities, etc). • Providing better environments in neighborhoods and schools to offer more opportunities for PA as an alternative to screens. |
| Physical Fitness | To collect nationally representative data on physical fitness for CAWD by: • Implementing a physical fitness evaluation protocol specifically designed for CAWD. • Measuring physical fitness in future national surveys to enhance data collection. To promote participation and activation of all children during physical education classes and organized sports while emphasizing enjoyment. This involves advocating for inclusive physical education practices and encouraging participation and enjoyment in organized sports for CAWD. To promote PA using a whole-school approach by: • Advocating for and implementing policies that support inclusive PA in schools. • Ensuring that schools prioritize and facilitate PA for all students, including those with disabilities. |
| Family and Peers | To promote family engagement by integrating parents into organized sports activities for children and youth, emphasizing the importance of active living with the family. To develop inclusive programs for PA in neighborhoods and green spaces, such as open or play streets, ensuring accessibility and diversity. To advocate for comprehensive policies that emphasize the benefits of active living in regulations addressing working hours and work environments while encouraging peer involvement in physical activities for CAWD. |
| School | To promote PA using a whole-school approach. In this process, the involvement of CAWD in the planning and feedback processes regarding activities and infrastructure changes is critical, ensuring their unique needs and preferences are considered. Also, create student-led initiatives that promote a culture of inclusivity and PA within the school community. To increase capacities and proficiency among education professionals with ongoing training on inclusive PA strategies and how to utilize and design adaptive equipment and activities effectively. To implement inclusive infrastructure with accessible and adaptable equipment and surfaces, ensuring that pathways and play areas are wheelchair-friendly and provide sensory-rich elements for a universally enjoyable play experience. |
| Community and Environment | To expand opportunities for PA in neighborhoods and green areas through community-based PA opportunities and programs like open or play streets, fostering community-wide engagement. To enhance infrastructure by improving safety and quality of pedestrian and bike paths, green areas, and residential streets by addressing lighting, aesthetics, and enforcing speed limits to create a conducive environment for outdoor activities. To promote inclusivity and accessibility for increasing participation in community organizations and sports clubs, particularly for CAWD and their families. |
| Government | To conduct a comprehensive audit of Chile’s PA policies, including all sectors (mobility, urban planning, education etc), to fully understand the policies coverage, gaps, and opportunities to improve alignment and coherence. To develop an objective method or rubric to grade this indicator, allowing for a critical follow-up in following PRC versions. To ensure an inclusive approach, revise the National Strategic Plan for PA and Sports 2016–2025 using the Global Action Plan on PA as a reference. |
| Overall recommendations | To develop a comprehensive and accurate data collection system for all indicators related to PA in CAWD. This will enable informed interventions and the assessment of initiative impacts. To foster inclusivity across educational, community, and policy domains. Effectively implement targeted programs, improve safety perceptions, and encourage collaboration among stakeholders to create an environment that promotes active lifestyles for individuals with disabilities. To improve communication and education strategies by: • Engaging mass media, particularly television and radio, in promoting the message of being physically active using evidence-based and pertinent approaches. • Increasing the dissemination and promotion of PA through official government channels, especially on social media. • Providing a platform for CAWD who engage in sports or recreational activities involving PA, using mass media for social marketing to inspire other children. Additionally, educate parents and caregivers about the range of activities that children with various conditions can engage in, addressing potential knowledge gaps or fears. |
Abbreviations: CAWD, children and adolescents with disabilities; PA, physical activity; PRCs, Para Report Cards.
Strengths and Limitations
The present PRC adopted the benchmarks and grading system from the Global Matrix of RCs developed by the AHKGA, aiming for comparability across various countries and jurisdictions. Adjustments were made to reflect CAWD populations as needed. Additionally, external auditing was conducted to validate the grades assigned to each indicator. Chile’s PRC used nationally representative data to assess most indicators and allowed for the grading of all but 2 indicators. The NSPASHCY 2019 provided sufficient data to grade 7 indicators. Although Chile has improved its PA surveillance in recent years, the NSPASHCY 2019 was the only source providing data for those aged 5–17, which is crucial for the current PRC indicators. It is important to note that some indicators were reported and supplemented with data from other sources (see Table 1), encompassing older samples (ie, 12 years and older). Consequently, the interpretation of grades should be approached with caution as the inclusion of younger samples may have influenced the grade outcomes. In addition, as the samples were small, data stratification according to different disability types (eg, physical, intellectual, sensorial) was not possible. For a more comprehensive understanding, future national surveys, especially those focused on CAWD, should encompass younger samples (ie, 5 to 12 years) and include diverse disabilities.
Conclusion
Chile’s first PRC revealed low grades for most indicators, with an overall D+ grade. The disparity between the grades of indicators regarding determinants of PA (such as Government) and those regarding PA behaviors (such as Active Transportation or Organized Sports and Physical Activity participation) suggests potential misalignments between policies and programs, lack of program coverage, and/or lack of effectiveness.
To bridge this gap, Chile must evaluate the quality, coherence, reach, and effectiveness of its existing policies. Establishing a well-coordinated system capable of defining realistic objectives; strategic planning; prioritizing resource allocation; monitoring progress; and aligning the efforts of health, sports, education, transportation, and urban planning sectors at both national and local levels is crucial. The findings from this PRC emphasize that maintaining the status quo is insufficient to address the prevalent issue of physical inactivity among CAWD in Chile. Substantive changes and a comprehensive approach are necessary to effectively combat this crisis.
Acknowledgments
The authors thank the international team developing the Global Matrix of PRCs 1.0 and the AHKGA for their support in developing this RC. Data availability statement: The data presented in this study are available on request from the corresponding author. Funding: This work was partially funded by the Universidad de La Frontera Research Directorate (DI21-0048, DI20-0002, DI20-0093). The funders had no role in the design of the study, in the writing of the manuscript, or in the decision to publish the manuscript.
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