THE EFFECTS OF SPORT AND PHYSICAL RECREATION FOR ADULTS WITH PHYSICAL AND INTELLECTUAL DISABILITIES: A SYSTEMATIC REVIEW WITH META-ANALYSIS

L. Hassett¹, M. McKay², J. Cole³, A. Moseley⁴, S. Chagpar⁴, M. Geerts⁴, W. Kwok⁴, C. Jensen⁴, C. Sherrington⁵, N. Shields⁶

¹The University of Sydney, Sydney School of Health Sciences/Institute for Musculoskeletal Health, Sydney, Australia, ²The University of Sydney, Sydney School of Health Sciences, Sydney, Australia, ³Disabled Wintersport Australia, Sydney, Australia, ⁴The University of Sydney, Institute for Musculoskeletal Health, Sydney, Australia, ⁵The University of Sydney, School of Public Health/Institute for Musculoskeletal Health, Sydney, Australia, ⁶La Trobe University, Melbourne, Australia

Background: Sixteen percent of the global population live with disability and are twice as likely not to meet physical activity guidelines for health benefits. Sport and physical recreation are types of leisure-time physical activity that can provide enjoyable opportunities for physical activity. Evidence of effectiveness of these activities has not been synthesised for people living with disability.

Purpose: To evaluate the effects of sport and physical recreation for adults living with physical and/or intellectual disability.​

Methods: Systematic review with meta-analysis of randomised controlled trials. Trials were identified from six electronic databases from inception to May 2022. Eligible trials included adult participants living with any physical or intellectual disability, comparing sport or physical recreation (excluding structured exercise programs) to non-active control. Primary outcomes were participation, activity (combined mobility, walking endurance and speed, balance), and quality of life; secondary outcomes were impairment (fatigue, depression, anxiety). Meta-analyses were conducted in REVMAN using random effects models. The GRADE approach was used to determine certainty of evidence.

Results: Seventy-two trials with 2,898 participants were included.Participants were majority female (54%), average age 55 years, living with predominantly physical disability from degenerative health conditions (67%). Only four trials included adults with an intellectual disability. No trials evaluated sport. The top four recreation activities were traditional Chinese exercise (36%), yoga (25%), dance (13%), and aquatic exercise (12%). All interventions were delivered to groups with a specific health condition. Where reported, intervention modifications were minor and additional equipment inexpensive. Most interventions were led by a person with experience or training in that activity (reported for 86% interventions), but fewer reported experience and/or training working with people with disability (36%). Health professional involvement was reported for 38% interventions, with physiotherapists most common.
Participation was measured predominantly as attendance and usually reported as sessions attended (mean attendance=81%, 29 intervention groups). There was low certainty evidence that recreation activities improves combined mobility (SMD 0.38, 95%CI 0.07 to 0.69, participants=469, comparisons=11, I²=61%) and walking endurance (MD 39.3m, 95%CI 18.2 to 60.4m, participants=774, comparisons=23, I²=69%); and very low certainty evidence that recreation improves balance (Berg Balance Scale, 0 to 56 points; MD 3.4 points, 95%CI 2.4 to 4.5, participants=879, comparisons=27, I²=77%) and does not improve walking speed (MD 0.03m/s, 95%CI -0.05 to 0.11m/s, participants=486, comparisons=13, I²=78%). There was low or very low certainty evidence that recreation improves quality of life, fatigue, depression, and anxiety.

Conclusions: Physical recreation likely confers multiple health benefits for people living with disability regardless of activity chosen, and therefore offers a potentially enjoyable and scalable strategy to increase physical activity in this population. Future trials should evaluate the effectiveness of sport for people living with disability and the effectiveness and acceptability of inclusive community-based recreation programs for people living with physical and/or intellectual disability.

Implications: Physiotherapists should promote physical activity to their patients. This might involve supporting referral to local community-based recreation activities when identified as a preference and providing advice and training to community providers to effectively and safely include people living with disability.

Funding acknowledgements: N/A

Keywords:
Disability
Physical activity
Systematic review

Topics:
Disability & rehabilitation
Health promotion & wellbeing/healthy ageing/physical activity
Neurology

Did this work require ethics approval? No

Reason: Systematic review.