Engaging in regular physical activity, getting enough sleep, and limiting time spent inactive are well known and evidence-based prescriptions for the promotion of overall health and well-being(Tremblay et al., 2016). In fact, the Canadian 24-Hour Movement Guidelines for Children and Youth (ages 5-17) — which consolidate the evidence-based daily requirements for physical activity and inactivity, as well as sleep, into a single comprehensive resource — recommends:
- At least 60 minutes of physical activity per day at a moderate to vigorous intensity;
- Several hours of “light” structured or unstructured physical activities;
- Uninterrupted sleep, ranging from 8 to 11 hours per night, depending on the age of the child or teen; and
- Less than two hours of recreational screen time per day.
The Guidelines use the tagline Sweat, Step, Sleep, Sit and a logo in the shape of a “4” to represent a “new movement paradigm that emphasizes the integration of all movement behaviours occurring over a whole day” – moderate to vigorous physical activity (“sweat”), light physical activity (“step”), sleep, and sedentary behaviours (“sit”). But what about the kids and teens who cannot stand, step, or sweat? The Guidelines do not include any evidence-based recommendations for children and youth with a disability.
Considering the Movement Habits of Children and Youth with Disabilities
To address this gap, a team of researchers from Queen’s University and the University of British Columbia set out to learn more about the potential inclusivity of the “sweat, step, sleep, sit” guidelines, and how the resource can be adapted for kids and teens of all abilities. Handler and colleagues (2019) interviewed 15 mothers of children and youth ages 6-17 with diverse physical and intellectual disabilities about their perceptions of the guidelines, and whether or not they considered them to be inclusive. (They attempted to interview fathers as well, but none responded to recruitment efforts). Here’s a brief snapshot of what they found:
- Only one participant was aware that 24-hour movement guidelines existed for children and youth before taking part in the study.
- The participants liked having the guidelines for each movement behaviour consolidated into one comprehensive resource.
- Although most participants found the guidelines simple to understand, participants struggled with the application – e.g. they didn’t know how to adapt the guidelines for their child’s specific condition or impairment, or how to differentiate between the various intensities of physical activity.
- In addition, the participants felt the guidelines were largely incompatible with the abilities, needs, and experiences of children and youth with disabilities. For example, sweating is not a biological function among certain types of disabilities, and stepping requires the ability to walk. The term “sit” and guideline statement “limit sitting for extended periods” were particularly contentious among mothers of children who use wheelchairs.
- To increase the compatibility of the guidelines, many participants stressed the need to acknowledge the potential differences that exist from child to child within the resource.
- Finally, participants suggested the need to revise the resource to make it more inclusive for children and youth with a disability, and provided recommendations for doing so.
Introducing the Ability Toolkit
Based on these findings, the research team, in consultation with parents of children and youth with a disability, developed the Ability Toolkit — a resource that translates the evidence-informed recommendations contained within the Canadian 24-Hour Movement Guidelines for Children and Youth into a practical tool for parents of kids and teens with a disability. In the Toolkit, users are provided with information that will assist them in adapting the guidelines to the unique movement abilities of individuals with any type of disability.
For example, when the different types of movement behaviours are described in the Ability Toolkit, the following statement is provided: “Everybody is different, so the same activity might fall in different categories for different children.” Examples of adapted activities (e.g., walking, running, wheeling) and equipment (e.g., arm ergometer, beeper ball) are listed in the toolkit to help parents find something that works for their child or teen, and that their child or teen enjoys.
Specific examples of adaptations for each daily movement behaviour include:
- Sweat: The Toolkit defines moderate to vigorous physical activities as those that require physical effort. Activities of this intensity will make children and teens feel tired and breathe harder than usual. Despite the label, the Toolkit notes that not every child or teen will sweat during these activities.
- Step: The Toolkit explains that light physical activities require a small amount of effort and will not make children or teens feel out of breath. In addition, parents are instructed that their child does not need to move the lower half of their body to perform these activities — “movement of any body part(s) can count as light physical activity.”
- Sleep: The toolkit notes that the closer a child or teen is to meeting the recommended hours of sleep per night, and the less interruptions there are, the greater the benefits will be.
- Sit: The toolkit clarifies that “seated positions are not always sedentary” and instructs parents of children in wheelchairs to change up seated or reclined positions. In general, parents are encouraged to implement short movement breaks throughout the day and limit recreational screen time.
The Ability Toolkit is an evidence-informed resource that paves the way towards more inclusive 24-hour movement guidelines for children and youth. Nonetheless, the need for disability-specific evidence and up-to-date statistics poses a serious challenge to the development of research-informed resources for children and youth with a disability. Until more research can bedone, products such as The Ability Toolkit offer inclusive alternatives to support families in the disability community.