A Statistics Canada survey on disability from 2017 found that children and adolescents with disabilities are at risk of experiencing symptoms of mental illness, including anxiety, secondary to their primary diagnoses. While physical activity has been identified as a strategy to reduce symptoms of anxiety and buffer the severity of anxiety-related symptoms in children and adolescents without disabilities, evidence on the relationship between anxiety and physical activity in children and adolescents with disabilities is limited.
A group of researchers from the University of Toronto Faculty of Kinesiology and Physical Education (KPE) worked with colleagues from Dalhousie University and the University of British Columbia to summarize and describe literature assessing the relationship between anxiety and physical activity in children and adolescents with disabilities in order to guide future research in this area.
“We found only eight studies that reported the relationship between anxiety and physical activity in children and adolescents with disabilities,” says Roxy Helliker O’Rourke, a PhD student at KPE and first author of the review recently published in the Children’s Health Care journal. “All eight reported a small inverse relationship between anxiety and physical activity, indicating higher physical activity levels to be associated with lower levels of anxiety.
“However, we also know that physical activity behaviours are often low amongst this population, so more work is needed to improve physical activity participation levels for children and adolescents with disabilities that may track from childhood through adolescence into adulthood.”
Future studies should focus on examining the anxiety and physical activity relationship in broader populations of children and adolescents with disabilities, according to senior author of the paper Kelly Arbour-Nicitopoulos, an associate professor at KPE specializing in physical activity and disability.
“The experience of living with disabilities is not the same for everyone,” she says. “It differs across impairment types, so a broader understanding of children and adolescents living with different impairment types is needed.”
For example, Arbour-Nicitopoulos explains, children who use non-speaking communication may experience social challenges within physical activity settings (where oral communication is prioritized), and children and adolescents who have a disability that is visible (e.g., an amputation) may be stigmatized by children and adolescents without disabilities, which may contribute to elevated anxiety experiences.
At the same time, there are potential additional benefits that children and adolescents with disabilities may experience within physical settings such as overcoming social isolation that is more often reported among children and adolescents with disabilities than without disabilities.
“We can see that there is a two-way relationship between physical activity and anxiety, where changes in physical activity are associated with changes in anxiety, and vice versa,” says Arbour-Nicitopoulos. “A better understanding of the relationship between anxiety and physical activity in children and adolescents with disabilities may help inform preventative measures and treatment options for anxiety.”
Additionally, the researchers stress the need to establish consistent definitions of anxiety and physical activity.
“Some of the studies we reviewed measured physical activity, while others looked at exercise, or sport,” says O’Rourke. “We encourage programmers and researchers to explore the quality of the physical activity environment because we cannot assume that any physical activity setting will contribute to reduced anxiety.
“Given that we know that, in general, greater physical activity is associated with lower anxiety, examining what type of physical activity, and how much of it, is most beneficial would be valuable when planning for physical activity interventions for different populations of children and adolescents with disabilities.”
The researchers also highlight the need to intentionally collect and report race and ethnicity, as well as socioeconomic status demographic characteristics within future research given the intersectional experience of disability and other demographic factors like race and gender.
“We encourage intentional recruitment of diverse populations with disabilities in research studies to better understand the physical activity and anxiety relationship in children and adolescents with disabilities, and importantly, marginalized subgroups within the larger population of children and adolescents with disabilities where physical activity and mental health services are often less accessible,” says O’Rourke. “Including members from the research population on the research team and developing community partnerships with diverse populations with disabilities are two strategies that may assist with recruiting diverse samples.”