P3.E098: A Global Overview of Barriers to Exercise in Children and Adolescents with Intellectual and Developmental Disabilities

Background: Intellectual and developmental disabilities (IDD) are lifelong limitations of intellectual, physical, or emotional development. Studies from multiple countries suggest children and adolescents with IDD (CAIDD) have higher obesity rates. This is particularly concerning because childhood obesity is associated with type 2 diabetes, hypertension, musculoskeletal problems, and obesity in adulthood, contributing to a decreased life expectancy of 12.7 years in individuals with IDD. Exercise can alleviate morbidity and mortality faced by CAIDD; however, barriers to exercise for this population are not well understood. In this study, we aim to understand the global variations in barriers to exercise for CAIDD.

Methods: This retrospective review examined data collected by the Special Olympics Healthy Athletes Program across 193 countries, separated into seven regions, between 2007 and 2020. We included 2866 participants (ages 0–21 years) with IDD who reported having no regular physical activity program. The primary outcome was which of nine barriers to exercise participants reported, totaling 3870 responses. χ² tests were used to test significance, at p< 0.001.

Results: 2906 participants were enrolled, with a mean age of 14.4 years (SD 4.7); 1212 (42.3%) were female. 589 participants lived in Africa, 698 in Asia Pacific, 172 in East Asia, 486 in Europe, 592 in Latin America, 34 in Middle East, and 335 in North America. The primary outcome had 3870 responses. For each region except Middle East, there was statistically significant variation in the frequency of reported barriers. In North America, Europe, and East Asia, the most frequent barrier was lack of interest (50.7%, 45.5%, and 57.8% respectively; all p< 0.001). By contrast, no facilities was the most frequent barrier in Latin America, Africa, and Asia Pacific (25.4%, 72.4%, and 25.6% respectively; all p< 0.001), as well as Middle East (52.9%, p=0.04). For all nine barriers there was regional variation in the likelihood each barrier was reported (all p< 0.001). Interest was most often cited in North America (RR 2.65), professional help in East Asia (RR 1.91), equipment in Africa (RR 1.65), exercise partner in Europe (RR 1.58), transportation in Africa (RR 2.15), finances in Africa (RR 2.16), physical ability in Latin America (RR 1.36), facilities in Asia Pacific (RR 2.32), and safety in Latin America (RR 3.53).

Conclusion: To our knowledge this is the largest study examining geographic differences in barriers to exercise for CAIDD. While further investigation is necessary to understand the underlying reasons certain barriers, especially lack of interest, are more prevalent in specific regions. Nevertheless, this study can help inform health policy and target interventions toward improving exercise frequency for CAIDD; thus, reducing the excess morbidity and mortality as well as minimizing health inequities faced by individuals with IDD.