EVIDENCE ON PHYSICAL ACTIVITY FOR CHILDREN, ADOLESCENTS AND ADULTS LIVING WITH DISABILITY

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WHO Guidelines on Physical Activity and Sedentary Behaviour. Geneva: World Health Organization; 2020.

WHO Guidelines on Physical Activity and Sedentary Behaviour.

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F1EVIDENCE ON PHYSICAL ACTIVITY FOR CHILDREN, ADOLESCENTS AND ADULTS LIVING WITH DISABILITY

Guiding Questions

F1.: What is the association between physical activity and health-related outcomes?

Inclusion Criteria

Population: People living with impairments as a result of any of the following health conditions:

F1.a.: Multiple sclerosis (MS)
F1.b.: Spinal cord injury (SCI)
F1.c.: Intellectual Disability (ID)
F1.d.: Parkinson’s disease (PD)
F1.d.: Stroke (Str)
F1.e.: Major clinical depression (MCD)
F1.g.: Schizophrenia (Sch)
F1.h.: ADHD

Exposure: Greater volume, duration, frequency or intensity of physical activity

Comparison: No physical activity or lesser volume, duration, frequency, or intensity of physical activity

		Outcomes
Population	1.1 Comorbidity	1.2 Physical functioning	1.3 Cognition	1.4 Quality of Life
F1.a Multiple sclerosis	✕	✕	✕	✕
F1.b Spinal cord injury	✕	✕		✕
F1.c Intellectual disability	✕	✕		✕
F1.d Parkinson’s disease		✕	✕
F1.e Stroke		✕	✕
F1.f Major clinical depression				✕
F1.g Schizophrenia			✕	✕
F1.h ADHD			✕

Evidence identified

Twenty-seven reviews were identified (published from 2016 to 2019) that examined the association between physical activity and health-related outcomes among people with impairments (Table F1.1) (1–38). Each of the reviews focused on different subpopulations with impairments including four reviews that included people with multiple sclerosis, no reviews among people with a spinal cord injury, two reviews among children and adolescents with intellectual disabilities including Down syndrome, three reviews among older adults with Parkinson’s disease, 12 reviews included people with a history of stroke, two reviews including people with major clinical depression, 3 reviews among adults with schizophrenia, and one among children with attention deficit hyperactivity disorder (Table F1.1).

The primary outcomes for each review varied according to the population of interest. For instance, measures of physical function were most commonly reported for reviews of exercise interventions among adults with a history of stroke whereas measures of cognition were most commonly reported for the reviews among children with ADHD. None of the reviews included evidence published in 2019; most reviews included evidence published through 2017. The included bodies of evidence for each review was relatively small ranging from 3 to 39 included studies. Three reviews were reviews-of-reviews and synthesized the evidence from existing systematic reviews and meta-analyses. Extracted data for each review is included in Appendix A. A summary of the U.S. Physical Activity Guidelines evidence for people with common chronic conditions is provided within each Evidence Profile.

In general, these reviews had many limitations in their design, execution, and reporting. None of the systematic reviews were rated as having high credibility based on the AMSTAR 2 instrument. Ten were rated as having moderate credibility, 14 were rated as having low credibility, and the remaining 12 were rated as having critically low credibility. Given concerns regarding the comprehensiveness and the validity of the results presented in reviews rated as having critically low credibility, they were not incorporated into the final Evidence Profiles. Table F1.2 presents the ratings for each review according to all the AMSTAR 2 main domains. Two additional reviews were excluded given the scope or focus of the reviews (7, 17). The paper by Christiansen 2019 (7) is not a systematic review and the review by Hendrey (2018) (17) was excluded given the research question (do resistance training interventions that have been studied among patients with a history of stroke adhere to American College of Sports Medicine guidelines?).

Table F1.1Systematic Reviews Assessed, by condition

	Conditions								Outcomes
Author, Year	MS	SCI	ID	Park	Stroke	MCD	Schizophrenia	ADHD	Risk of comorbid conditions	Physical function	Cognitive function	QOL	Last search date	# of included studies	AMSTAR 2
People with multiple sclerosis
Alphonsus, 2019 (1)	✕											✕	NR 2017	18	Low
Campbell, 2018 (5)	✕									✕			Sep 2017	7	Low
Charron, 2018 (6)	✕									✕			Nov 2016	12	Critically Low
Manca, 2018 (24)	✕									✕			May 2017	11	Moderate
Morrison, 2017 (27)	✕										✕		May 2016	19	Critically Low
Patterson, 2018 (28)	✕	✕			✕					✕			Aug 2017	9	Moderate
Veneri, 2018 (34)	✕				✕					✕	✕	✕	May 2016	32	Critically Low
People with spinal cord injury
Eitivipart, 2019^a (12)		✕								✕			Aug 2018	16	Critically Low
Gaspar, 2019 (14)		✕								✕		✕	Feb 2017	25	Critically Low
Melo, 2019 (25)		✕								✕			Nov 2015	7	Critically Low
Patterson, 2018 (28)	✕	✕			✕					✕			Aug 2017	9	Critically Low
People with intellectual disabilities
Maïano, 2018 (23)			✕							✕			Mar 2018	15	Low
Maïano, 2019 (22)			✕							✕			Jun 2017	11	Moderate
People with Parkinson’s disease
Cugusi, 2017a (8)				✕						✕		✕	Feb 2017	6	Low
Ćwiękała-Lewis, 2017 (10)				✕						✕		✕	Apr 2015	11	Critically Low
Dos Santos Delabary, 2017 (11)				✕						✕		✕	Aug 2017	5	Low
Kalyani, 2019 (19)				✕						✕	✕		Sep 2017	12	Critically Low
Stuckenschneider, 2019 (32)				✕							✕		Mar 2018	11	Moderate
People with a history of stroke
Bonini-Rocha, 2018 (3)					✕					✕			Mar 2017	11	Moderate
Boyne, 2017 (4)					✕					✕			Nov 2015	20	Low
Cugusi, 2017b (9)					✕					✕			Oct 2016	15	Moderate
Ge, 2017 (15)					✕					✕			Feb 2017	32	Moderate
Hendrey, 2018^b (17)					✕					✕			Oct 2016	39	N/A
Ilunga Tshiswaka, 2018 (18)					✕					✕			Oct 2016	29	Critically Low
Li, 2018 (21)					✕					✕			NR	5	Low
Miranda, 2018 (26)					✕					✕			Nov 2017	12	Low
Patterson, 2018 (28)	✕	✕			✕					✕			Aug 2017	9	Moderate
Pogrebnoy, 2019 (29)					✕					✕			Aug 2018	10	Low
Schröder, 2019 (30)					✕					✕			Apr 2018	7	Low
Veneri, 2018 (34)	✕				✕					✕	✕	✕	NR	32	Critically Low
Wiener, 2019 (35)					✕					✕			Jan 2018	6	Low
Wu, 2018 (36)					✕					✕			May 2017	6	Critically Low
Zou, 2018a (37)					✕					✕			NR	20	Low
Zou, 2018b (38)					✕				✕	✕			NR	16	Low
People with major clinical depression
Ashdown-Franks, 2019^a (2)						✕	✕	✕	✕		✕		Jan 2018	27	Moderate
Krogh, 2017 (20)						✕			✕			✕	Jun 2017	35	Moderate
Stubbs, 2018^a (31)						✕	✕		✕	✕	✕	✕	Jan 2018	20	Moderate
People with schizophrenia
Ashdown-Franks, 2019^a (2)						✕	✕	✕	✕		✕		Jan 2018	27	Moderate
Firth, 2016 (13)							✕				✕		Apr 2016	10	Low
Stubbs, 2018^a (31)						✕	✕		✕	✕	✕	✕	Jan 2018	20	Critically Low
People with attention deficit hyperactivity disorder
Ashdown-Franks, 2019^a (2)						✕	✕	✕	✕		✕		Jan 2018	27	Moderate
Christiansen, 2019^c (7)								✕			✕		NR	18	N/A
Grassmann, 2017 (16)								✕			✕		NR 2013	3	Critically Low
Suarez-Manzano, 2018 (33)								✕			✕		Jan 2017	16	Critically Low

: Abbreviations: ADHD = attention deficit hyperactivity disorder; ID = intellectual disorder; MCD = major clinical depression; MS = multiple sclerosis; NR = month and/or year not reported; QOL = quality of life; SCI = spinal cord injury
a: Review-of-reviews
b: Review excluded given scope
c: Not a systematic review

Table F1.2Credibility Ratings (AMSTAR 2)

Author, Year	PICO¹	Apriori Methods²	Study Design Selection³	Lit Search Strategy⁴	Study Selection⁵	Data Extraction⁶	Excluded Studies⁷	Included Studies⁸	RoB Assessment⁹	Funding Sources¹⁰	Statistical Methods¹¹	Impact of RoB¹²	RoB Results¹³	Heterogeneity¹⁴	Publication Bias¹⁵	COI¹⁶	Overall Rating¹⁷
Alphonsus, 2019	Y	N	N	PY	Y	N	PY	N	PY	N	Y	Y	Y	Y	Y	N	Low
Ashdown-Franks, 2019	Y	N	N	PY	Y	Y	PY	Y	Y	N	N/A	N/A	Y	Y	N/A	Y	Moderate
Bonini-Rocha, 2018	Y	N	N	PY	Y	N	PY	PY	Y	N	Y	N	Y	Y	Y	Y	Moderate
Boyne, 2017	Y	N	N	PY	N	N	PY	PY	PY	N	Y	N	N	Y	Y	N	Low
Campbell, 2018	Y	N	N	PY	N	N	PY	PY	PY	N	N/A	N/A	N	Y	N/A	Y	Low
Charron, 2018	Y	N	N	PY	N	N	PY	PY	N	N	N/A	N/A	N	N	N/A	Y	Critically Low
Cugusi, 2017a	Y	N	N	PY	Y	Y	Y	PY	PY	N	N/A	N/A	N	Y	N/A	Y	Low
Cugusi, 2017b	N	N	N	PY	Y	Y	Y	Y	Y	N	Y	N	N	Y	Y	Y	Moderate
Ćwiękała-Lewis, 2017	N	N	N	PY	N	N	PY	PY	N	N	N/A	N/A	N	N	N/A	Y	Critically Low
Dos Santos Delabary, 2017	Y	N	N	PY	Y	Y	PY	PY	Y	N	Y	N	N	Y	Y	Y	Low
Eitivipart, 2019¹⁸	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	Critically Low
Firth, 2016	Y	N	N	PY	Y	N	PY	PY	Y	N	Y	Y	Y	Y	Y	Y	Low
Gaspar, 2019	N	N	N	PY	Y	Y	N	N	N	N	N/A	N/A	N	Y	N/A	N	Critically Low
Ge, 2017	Y	N	N	PY	Y	Y	PY	PY	Y	N	Y	N	Y	Y	Y	N	Moderate
Grassmann, 2017	Y	N	N	PY	N	N	N	PY	N	N	N/A	N/A	N	N	N/A	Y	Critically Low
Ilunga Tshiswaka, 2018	N	N	N	PY	Y	N	N	N	N	N	N/A	N/A	N	N	N/A	Y	Critically Low
Kalyani, 2019	Y	PY	N	PY	Y	Y	PY	PY	Y	N	N	N	Y	N	N	N	Critically Low
Krogh, 2017	Y	PY	N	PY	Y	Y	N	Y	Y	Y	Y	Y	Y	Y	Y	Y	Moderate
Li, 2018	Y	N	N	PY	Y	Y	PY	PY	Y	N	Y	N	Y	Y	N	Y	Low
Maïano, 2018	Y	N	N	PY	Y	Y	N	Y	PY	N	Y	Y	Y	Y	Y	Y	Low
Maïano, 2019	Y	N	N	PY	Y	Y	PY	Y	Y	N	N/A	N/A	Y	N	N/A	Y	Moderate
Manca, 2018	Y	N	N	PY	Y	Y	Y	PY	Y	N	Y	N	Y	Y	Y	Y	Moderate
Melo, 2019	Y	N	N	PY	Y	Y	PY	PY	N	N	N/A	N/A	N	N	N/A	N	Critically Low
Miranda, 2018	N	N	N	PY	N	Y	Y	Y	PY	N	N/A	N/A	Y	Y	N/A	Y	Low
Morrison, 2017	N	N	N	PY	N	N	N	Y	PY	N	N/A	N/A	Y	N	N/A	Y	Critically Low
Patterson, 2018	Y	N	N	PY	Y	Y	PY	PY	Y	N	N/A	N/A	Y	Y	N/A	Y	Moderate
Pogrebnoy, 2019	Y	N	Y	PY	Y	N	PY	PY	PY	N	Y	N	N	Y	N	N	Low
Schröder, 2018	Y	N	N	PY	Y	Y	N	PY	Y	N	N/A	N/A	Y	Y	N/A	Y	Low
Stubbs, 2018	Y	N	Y	PY	Y	Y	PY	PY	Y	N	N/A	N/A	Y	Y	N/A	Y	Moderate
Stuckenschneider, 2019	Y	N	N	PY	N	Y	PY	Y	PY	N	N/A	N/A	Y	Y	N/A	Y	Moderate
Suarez-Manzano, 2018	N	N	N	PY	Y	N	N	PY	N	N	N/A	N/A	N	N	N/A	Y	Critically Low
Veneri, 2018	N	N	N	PY	Y	N	N	PY	N	N	N	N	N	N	N	Y	Critically Low
Wiener, 2019	Y	N	N	PY	Y	N	N	PY	PY	N	N/A	N/A	N	Y	N/A	Y	Low
Wu, 2018	Y	N	N	PY	Y	Y	N	PY	N	N	N	N	Y	Y	N	N	Critically Low
Zou, 2018a	Y	N	N	PY	Y	Y	PY	PY	PY	N	Y	Y	Y	Y	Y	N	Low
Zou, 2018b	Y	N	N	PY	Y	Y	PY	PY	PY	N	N	N	Y	Y	N	Y	Low

: Abbreviations: COI = conflict of interest; N = no; N/A = not applicable; PICO = population, intervention, comparator, outcome; PY = partial yes; RoB = risk of bias; Y = yes
1: Did the research questions and inclusion criteria for the review include the components of PICO?
2: Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any significant deviations from the protocol?
3: Did the review authors explain their selection of the study designs for inclusion in the review?
4: Did the review authors use a comprehensive literature search strategy?
5: Did the review authors perform study selection in duplicate?
6: Did the review authors perform data extraction in duplicate?
7: Did the review authors provide a list of excluded studies and justify the exclusions?
8: Did the review authors describe the included studies in adequate detail?
9: Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review?
10: Did the review authors report on the sources of funding for the studies included in the review?
11: If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results?
12: If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or other evidence synthesis?
13: Did the review authors account for RoB in individual studies when interpreting/ discussing the results of the review?
14: Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review?
15: If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review?
16: Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?
17: Shea et al. 2017. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both.
18: Eitivipart, 2019 is a review-of-reviews. All included reviews were rated as critically low by review authors and was therefore rated as critically low overall.

F.1. Physical Activity in children, adolescents and adults living with disability

Table F.1.a. People with multiple sclerosis, relationship between physical activity and health-related outcomes (PDF, 109K)

Questions: What is the association between physical activity and health-related outcomes?

Population: People with multiple sclerosis

Exposure: Greater volume, duration, frequency, or intensity of physical activity

Comparison: No physical activity or lesser volume, duration, frequency, or intensity of physical activity

Outcome: Risk of co-morbid conditions (including disease progression and symptoms of disease), physical function, cognitive function, health-related QOL

Table F.1.b. People with spinal cord injury, relationship between physical activity and health-related outcomes (PDF, 69K)

Questions: What is the association between physical activity and health-related outcomes?

Population: People with spinal cord injury

Exposure: Greater volume, duration, frequency, or intensity of physical activity

Comparison: No physical activity or lesser volume, duration, frequency, or intensity of physical activity

Outcome: Risk of co-morbid conditions (including disease progression and symptoms of disease), physical function, health-related QOL

Table F.1.c. People with intellectual disabilities, relationship between physical activity and health-related outcomes (PDF, 83K)

Questions: What is the association between physical activity and health-related outcomes?

Population: People with intellectual disabilities

Exposure: Greater volume, duration, frequency, or intensity of physical activity

Comparison: No physical activity or lesser volume, duration, frequency, or intensity of physical activity

Outcome: Risk of co-morbid conditions (including disease progression and symptoms of disease), physical function, health-related QOL

Table F.1.d. People with Parkinson’s disease, relationship between physical activity and health-related outcomes (PDF, 106K)

Questions: What is the association between physical activity and health-related outcomes?

Population: People with Parkinson’s disease

Exposure: Greater volume, duration, frequency, or intensity of physical activity

Comparison: No physical activity or lesser volume, duration, frequency, or intensity of physical activity

Outcome: Physical function, cognitive function

Table F.1.e. People with history of stroke, relationship between physical activity and health-related outcomes (PDF, 98K)

Questions: What is the association between physical activity and health-related outcomes?

Population: People with history of stroke

Exposure: Greater volume, duration, frequency, or intensity of physical activity

Comparison: No physical activity or lesser volume, duration, frequency, or intensity of physical activity

Outcome: Physical function, cognitive function

Table F.1.f. People with major clinical depression, relationship between physical activity and health-related outcomes (PDF, 77K)

Questions: What is the association between physical activity and health-related outcomes?

Population: People with major clinical depression

Exposure: Greater volume, duration, frequency, or intensity of physical activity

Comparison: No physical activity or lesser volume, duration, frequency, or intensity of physical activity

Outcome: Health-related QOL

Table F.1.g. People with schizophrenia, relationship between physical activity and health-related outcomes (PDF, 77K)

Questions: What is the association between physical activity and health-related outcomes?

Population: People with schizophrenia

Exposure: Greater volume, duration, frequency, or intensity of physical activity

Comparison: No physical activity or lesser volume, duration, frequency, or intensity of physical activity

Outcome: Cognitive function, health-related QOL

Table F.1.h. People with attention deficit hyperactivity disorder (ADHD), relationship between physical activity and health-related outcomes (PDF, 75K)

Questions: What is the association between physical activity and health-related outcomes?

Population: People with attention deficit hyperactivity disorder (ADHD)

Exposure: Greater volume, duration, frequency, or intensity of physical activity

Comparison: No physical activity or lesser volume, duration, frequency, or intensity of physical activity

Outcome: Cognitive function

Appendix A. Data Extractions

Download PDF (226K)

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WHO Guidelines on Physical Activity and Sedentary Behaviour. Geneva: World Health Organization; 2020. F1, EVIDENCE ON PHYSICAL ACTIVITY FOR CHILDREN, ADOLESCENTS AND ADULTS LIVING WITH DISABILITY.
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Guiding Questions
Inclusion Criteria
Evidence identified
Physical Activity in children, adolescents and adults living with disability
Data Extractions
References

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WHO Guidelines on Physical Activity and Sedentary Behaviour.

F1EVIDENCE ON PHYSICAL ACTIVITY FOR CHILDREN, ADOLESCENTS AND ADULTS LIVING WITH DISABILITY

Guiding Questions

Inclusion Criteria

Evidence identified

Table F1.1Systematic Reviews Assessed, by condition

Table F1.2Credibility Ratings (AMSTAR 2)

F.1. Physical Activity in children, adolescents and adults living with disability

Appendix A. Data Extractions

References

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