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State-of-the-Art Pediatrics

July 2020

Movement is Medicine: Adaptive Fitness and Sports

 

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Author: Mark Fisher, MD, FAAPMR | Director, Adaptive Sports Medicine Program |Assistant Professor of Pediatrics, Division of Pediatric Rehabilitation Medicine 

    
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Column editor: Amita R. Amonker, MD | Pediatric Hospitalist | Assistant Professor of Pediatrics, UMKC School of Medicine 

Whether we regularly prescribe exercise in our practice or not, physicians know that it can be a powerful medical intervention across the lifespan. Conversely, we know that lack of physical activity has profoundly negative effects on our health. With alarming rates of obesity and sedentary lifestyles in the general population, it is no surprise that the vulnerable population of children and adults with disabilities are often overwhelmed by personal and community barriers to physical activity. Of children aged 5-17 in the United States, 5.6% have disability.1 Currently, these children have access to fewer community resources for physical activity and have limited access to adaptive sports medicine tailored to their unique physical and cognitive needs.

What is Adaptive Sports Medicine?

Adaptive sports medicine is the prevention, diagnosis, management and therapeutic support for disability-specific health concerns related to participation in mainstream sports, disability-specific sports and exercise.

According to a U.S. Department of Health and Human Services report in 2010, 8.9% of children ages 6-19 with a disability meet basic guidelines for physical activity. Of those with disabilities, 51-54% participated in ZERO leisure time physical activity and had 13-53% less habitual physical activity than their peers.2 There are disproportionate rates of social isolation, depression, sadness and chronic diseases such as obesity, diabetes and cardiovascular disease.3,4 Some of the largest barriers to adaptive physical activity and sport include cost, accessibility, degree of impairment, transportation, availability and knowledge of activities.5 It should be noted that students with disability are still largely excluded from interscholastic athletics in public schools across the country. The primary facilitators for engaging in physical activity are the desire to create social contacts, improve physical fitness, and improve health.5 Unfortunately, due to the variety and complexity of many of these patients’ disabilities, they are 30-50% less likely to receive exercise counseling from a health care provider.6

Peer-Reviewed Benefits of Adaptive Sports and Physical Activity:

  • Improves metabolic profile: body fat, lean muscle, blood pressure, heart rate, lipid profile, bone density.
  • Mental health and quality of life: improves social integration, self-esteem, self-perceived quality of life, self-efficacy, body image, empowerment, school performance, motivation for continued involvement, reduces depression and detrimental effects of disability on mental health.
  • Improves physical profile across wide range of disabilities: strength, endurance, flexibility, gait efficiency, gait mechanics and wheelchair propulsion.
  • Participation improves likelihood of employment in working age.

To support our patients, one must first support equitable access to facilities, equipment and adapted programs. Access to fitness facilities and adaptive sports programs encourages children with disability to engage socially with their peers while having positive experiences with sports and exercise. By building upon these experiences, they begin to identify as an athlete and grow their self-concept. This focus on self-efficacy and confidence is critical for children who are then more likely to continue a physically active lifestyle and overcome barriers in other areas of life.

As these youth begin this journey, they should be screened with a pre-participation history and exam. Current pre-participation physical structure is insufficient for this complex population as a significant abnormality is found in approximately 40% of Para and Special Olympians compared to a 1-3% incidence found in able-bodied athletes.7 The adaptive physical should address type of impairment (motor/sensory/cognitive), level of independence, level of training, adaptive equipment, medications and specific risk factors associated with the chosen activity. If the pre-participation physical and anticipatory guidance is performed by the physician involved in the longitudinal care of the adaptive athlete, they can easily expand upon the knowledge of baseline functioning and previous rehabilitation interventions.

Overall, literature has shown that adaptive athletes have roughly the same injury rates as able-bodied athletes. However, musculoskeletal injuries often have a greater functional consequence in the daily lives of athletes with disabilities. Altered biomechanics in wheelchair athletes or athletes using a prosthesis can predispose to overuse injury or entrapment neuropathies. Spinal cord dysfunction may predispose the athlete to autonomic dysreflexia, impaired thermoregulation, or problems with skin integrity in insensate areas. Altered nutritional needs put these athletes at risk of relative energy deficiency and decreased bone density. Those with neuromuscular pathology may require specific guidelines to avoid an overwork phenomenon. Anticipatory guidance regarding principles of biomechanics and injury prevention are of paramount importance to preserve athlete health and function throughout life.8

The Adaptive Sports Medicine Program at Children’s Mercy has been designed to meet the needs of these unique patients. For those who already are active or an elite adaptive athlete, it ensures equitable access to tailored sports medicine care. As health care providers, we have an opportunity to promote health, promote movement as medicine, and promote inclusion for adaptive sports and recreation.

References

  1. National Institute on Disability: Disability Statistics Annual Report 2017. Kraus L, Lauer E, Coleman, R, Houtenville A. (2018). Durham, NH: University of New Hampshire.
  2. Differences in Habitual Physical Activity Levels of Young People With Cerebral Palsy and Their Typically Developing Peers: A Systematic Review. Carlon SL et al. Disabil Rehabil 2013;35:647–55.
  3. Chronic Illness, Disability and Mental and Social Well-being: Findings of the Ontario Child Health Study. Cadman D, Boyle M, Szatmari P, Offord DR. Pediatrics. 1987;79:805–813.
  4. Prescribing Exercise to Individuals With Disabilities: What are the Concerns? Osorio H, Blauwet CA. Curr Sports Med Rep. 2017 Jul/Aug;16(4):268-273.
  5. Impact of Adaptive Sports Participation on Quality of Life. Diaz R et al. SportsMed Arthrosc Rev. 2019 Jun;27(2):73-82.
  6. Obesity Among Adults with Disabling Conditions. Weil E et al: JAMA 2002;288:1265–8.
  7. The Special Olympics Athlete: Evaluation and Clearance for Participation. Birrer RB. Clin Pediatr (Phila). 2004 Nov-Dec;43(9):777-82.
  8. More Than Just a Game: The Public Health Impact of Sport and Physical Activity for People With Disabilities. Blauwet CA. Am J Phys Med Rehabil 2019;98:1–6.