Physical Activity and Sedentary Time among Children with Disabilities at School

Abstract

Purposes:
Physical activity (PA) is important for the development of children with disabilities, but rarely does this population meet the recommended standards. Schools are salient locations for PA, but little is known about how specific school settings affect the PA of children with diverse disabilities. We assessed PA and sedentary time (ST) of children with disabilities in three school settings (physical education, recess, lunchtime).

Methods:
Participants included 259 children from 13 Hong Kong special schools for five primary disabilities: visual impairments, hearing impairments, physical disabilities, intellectual disabilities, and social development problems. Children wore accelerometers at school for 3 d, and the time (min and %) they engaged in moderate-to-vigorous PA (MVPA) and ST was extracted for each school setting by sex. Analyses included multiple linear mixed models to determine differences in MVPA and ST by sex across disability types, adjusting for body mass index, grade level, and duration in each setting.

Results:
Overall, children spent 70% of their day at school being sedentary and accrued little MVPA (mean, 17 ± 4.2 min daily). Children with intellectual disabilities (severe) had especially low levels of MVPA. All three settings contributed significantly to both MVPA and ST, with recess contributing more to MVPA than physical education or lunchtime.

Conclusions:
This is the first study to examine MVPA and ST among different disability types at school using accelerometry. Given the low levels of PA, this population should receive priority in the development of cost-effective interventions to improve their PA opportunities.

Full text

Physical Activity and Sedentary Time among
Children with Disabilities at School
CINDY H. P. SIT
1
, THOMAS L. MCKENZIE
2
, ESTER CERIN
3,4
, BIK C. CHOW
5
, WENDY Y. HUANG
5
, and JIE YU
1
1
Department of Sports Science and Physical Education, the Chinese University of Hong Kong, HONG KONG;
2
School of
Exercise and Nutritional Sciences, San Diego State University, San Diego, CA;
3
Institute for Health and Ageing, Australian
Catholic University, Melbourne, AUSTRALIA;
4
School of Public Health, The University of Hong Kong, HONG KONG;
5
Department of Physical Education, Hong Kong Baptist University, HONG KONG
ABSTRACT
SIT, C. H. P., T. L. MCKENZIE, E. CERIN, B. C. CHOW, W. Y. HUANG, and J. YU. Physical Activity and Sedentary Time among
Children with Disabilities at School. Med. Sci. Sports Exerc., Vol. 49, No. 2, pp. 292–297, 2017. Purposes: Physical activity (PA) is
important for the development of children with disabilities, but rarely does this population meet the recommended standards. Schools are
salient locations for PA, but little is known about how specific school settings affect the PA of children with diverse disabilities. We assessed
PA and sedentary time (ST) of children with disabilities in three school settings (physical education, recess, lunchtime). Methods: Partic-
ipants included 259 children from 13 Hong Kong special schools for five primary disabilities: visual impairments, hearing impairments,
physical disabilities, intellectual disabilities, and social development problems. Children wore accelerometers at school for 3 d, and the time
(min and %) they engaged in moderate-to-vigorous PA (MVPA) and ST was extracted for each school setting by sex. Analyses included
multiple linear mixed models to determine differences in MVPA and ST by sex across disability types, adjusting for body mass index, grade
level, and duration in each setting. Results: Overall, children spent 70% of their day at school being sedentary and accrued little
MVPA (mean, 17 T4.2 min daily). Children with intellectual disabilities (severe) had especially low levels of MVPA. All three
settings contributed significantly to both MVPA and ST, with recess contributing more to MVPA than physical education or
lunchtime. Co nclusions: This is the first study to examine MVPA and ST among different disability types at school using
accelerometry. Given the low levels of PA, this population should receive priority in the development of cost-effective interventions
to improve their PA opportunities. Key Words: ACCELEROMETER, HEALTH, YOUTH, SPECIAL NEEDS, RECESS, PHYSI-
CAL EDUCATION
Physical inactivity is a serious public health problem,
and the association of physical inactivity with obesity
and obesity-related chronic diseases in children is
well documented (35). Healthy People 2020 reaffirms the
importance of physical activity (PA) and identifies ‘‘Dis-
ability and Health’’ as one of the topic areas that require
further investigation (33). Evidence indicates that children
with disabilities do not meet the recommended 60 minId
j1
of moderate-to-vigorous PA (MVPA) (24). Compared with
their typically developing peers, children with disabilities
are much less physically active, tend to engage more in
sedentary pursuits, and are at three to six times greater risk
for obesity (18). Increasing PA in children with disabilities
is therefore important for reducing the prevalence of obesity
as well as a number of secondary conditions, and thus is a
public health priority (33).
Social–ecological models of health behavior that focus on
environmental influences on PA are becoming more widely
used in research (15). Schools, for example, are important
settings where children can engage in health-promoting PA
during the day (21,35), and the Institute of Medicine"s recent
report suggests that schools should provide at least 50% of
the 60 min of daily recommended MVPA (14,34). Sample
standards or guidelines for PA at schools include having
daily active physical education (PE) (i.e., at least 50% lesson
time in MVPA) (21,32), daily recess of at least 20 min (17),
and after school programs that engage children in any PA for
at least 17% of the time (1). Previous studies suggest that PE
contributes modestly to total daily MVPA and that recess
and afterschool programs can contribute up to at least a third
of the recommended levels (23,31).
In Hong Kong, the Education Bureau recommends that
5%–8% of the total school curriculum time be allocated to PE
(equivalent to 70–80 minIwk
j1
) (7). There are no specific
guidelines, however, for time allocations for recess or other
PA settings in special schools. Meanwhile, direct observation
studies indicate that Hong Kong children with disabilities
accrue little PA during recess and PE (30), and that during
recess and lunchtime, they may accrue more PA than during
Address for correspondence: Cindy H. P. Sit, Ph.D., Department of Sports
Science and Physical Education, The Chinese University of Hong Kong,
Shatin, New Territories, Hong Kong; E-mail: sithp@cuhk.edu.hk.
Submitted for publication May 2016.
Accepted for publication September 2016.
0195-9131/17/4902-0292/0
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DOI: 10.1249/MSS.0000000000001097
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on campus before and after school periods (28). Additional
research, especially using objective methods, needs to be
conducted among children with disabilities to understand
the contributions of structured settings to PA and sedentary
behavior at school.
A recent study using accelerometers during PE and recess
reported that the children with intellectual disabilities did not
meet recommended levels for PA during these school
settings (19). Other studies have also used accelerometers to
examine PA and sedentary time (ST) with children with
physical (22,26) and intellectual disabilities (10). Regardless
of disability type, children tend to spend a small amount of
school time in MVPA and a great amount in sedentary pursuits.
For example, Bingham et al. (2) examined both MVPA and ST
of children with autism, behavioral, and emotional challenges,
and other special needs. They found those with behavioral and
emotional needs were more active than others, but over 80% of
the children failed to meet PA guidelines. Although these
studies are important, additional investigations are needed
to advance the understanding of PA and ST of children with
diverse types of disabilities during school time. The purpose
of the present study was to use accelerometry to objectively
assess the PA and ST of boys and girls with different dis-
ability types in school PA settings including PE. A secondary
purpose was to determine the relative contributions of the
accrual of PA and ST in these settings to overall school
MVPA and ST in children with disabilities.
METHODS
Participants. During the 2013–2014 school year, 7834
children were enrolled in 60 Hong Kong special schools
(excluding one English Foundation Special School) (9).
With the exception of hospital schools, special schools for
five main disability types were in operation: visual im-
pairment (VI) (n= 2), hearing impairment (HI) (n=2),
physical disability (PD) (n= 7), intellectual disability (ID)
(n= 41), and social development (SD) (n= 7). These schools
typically housed grades 1–12 and provided educational ser-
vices to one class of students per grade level composed of
10–15 students (except for children with VI). Our cross-
sectional study, conducted between November 2013 and
March 2014, included 313 Chinese boys and girls enrolled
in 13 of the special schools selected using a purposive
sampling method. These individual schools and their cur-
ricula were designed specifically for children with VI, HI,
PD, ID (mild, moderate, severe), and SD problems. Written
informed parental consent and child assent were obtained
for each participant. The study complied with the principles
of the Declaration of Helsinki and was approved by the
Joint Chinese University of Hong Kong-New Territories East
Cluster Clinical Research Ethics Committee.
Measures. Children"s PA levels were assessed using
accelerometry (GT3X model; ActiGraph, Pensacola, FL), an
objective and widely used measure of PA in children, including
those with disabilities (4). With the assistance of trained
research assistants and teachers, children wore the acceler-
ometer on an elastic belt above the right hip at school during
three normal weekdays spread over a 1-month period. Data
were collected in a 15-s epoch, and the original counts were
quantified into either ST (e100 counts per minute) or MVPA
(Q2296 counts per minute) based on the cutoff points suggested
by Evenson et al. (11). Evenson cutpoints have been used and/
or validated previously with children with disabilities (4–6).
TheamountoftimechildrenengagedinSTandMVPA
were extracted from the times they participated in structured
PA programs in six different settings (i.e., before school,
regular PE classes, recess, lunchtime, after school, and re-
habilitation sessions) during the three measurement days.
Participants"height and weight were obtained from the
schools, and body mass index (BMI) was calculated.
Statistical analysis. Mean and standard deviations were
calculated to describe time in each setting and total wear time.
We examined MVPA and ST during overall school time and
during three separate settings (PE, recess, and lunchtime). Of
13 schools, only five schools provided before and after ac-
tivity programs or rehabilitation sessions, so these contexts
were not analyzed separately. To compare children"s MVPA
and ST across disability types in different settings, linear mixed
models (LMM) were performed. LMM were chosen because
they can deal with incomplete data sets with repeated measures
(i.e., three measurement days) and adjustments for school-level
clustering. Children with ID of severe level were taken as a
reference category in LMM. Models, adjusting for BMI, grade
level, and duration of the specific school setting (PE, recess, and
lunchtime) were estimated for boys and girls separately. The
contribution of time–segment MVPA and ST for each of the
three settings to overall school MVPA and ST by sex were
further determined by LMM, adjusting for BMI, grade level,
and wear time. Statistical analyses were performed using SPSS
version 22.0, and Pvalue was set at 0.05.
RESULTS
Of the 313 students initially recruited to participate in the
study, 23 were not categorized into a specific disability type,
eight had missing gender information, 15 with PD needed
walking assistance or were wheelchair bound, and eight stu-
dents did not have valid accelerometer data for at least 1 d. They
were excluded from all analyses, resulting in a final dataset of
259 students (mean age, 13.04 T4.45 yr; range, 6–23 yr),
most of whom (71.8%) were children with ID (Table 1). The
TABLE 1. Number of children by disability type and sex (total n= 259).
Type of Special School Boys Girls Total
Visual impairment 11 10 21
Hearing impairment 7 5 12
Physical disability 14 13 27
Intellectual disability (mild) 55 37 92
Intellectual disability (moderate) 36 23 59
Intellectual disability (severe) 18 17 35
Social development problems 13 0 13
Total 154 105 259
PHYSICAL ACTIVITY IN CHILDREN WITH DISABILITY Medicine & Science in Sports & Exercise
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grade level and BMI of children excluded from data analyses
did not differ from those retained. Table 2 shows that stu-
dents wore the accelerometers at school for an average of
412.7 minId
j1
(6.9 h). Overall, they spent 17 min (4.2%) of
the school day in MVPA, 106 min (25.8%) in light PA, and
289 min (70.0%) in ST. Specific to the three settings, children
spent an average of 7.2 min (13.2%) engaging in MVPA
during PE, 3.0 min (9.4%) during recess, and 2.9 min (4.5%)
during lunchtime.
Table 3 compares the total daily MVPA and ST at school
by sex across the disability types. After controlling for con-
founders, boys with mild ID, moderate ID, and SD problems
were more physically active than boys with severe ID. Boys
with severe ID were more sedentary than boys with other
disability types. Among girls, there were no significant dif-
ferences in MVPA across the disability types. Girls with VI,
mild ID, and severe ID, however, were less sedentary than
girls with severe ID.
Tables 4 to 6 compare MVPA and ST for boys and girls
during PE lessons, recess, and lunch periods across the dis-
ability types, with adjustments for BMI, grade level, and
specific school setting. Table 4 shows that, compared with
boys with severe ID, boys with VI and SD problems had
significantly more MVPA min (VI: b= 16.17; 95% confi-
dence interval [CI], 7.05–25.05; SD problems: b=18.00;
95% CI, 8.91–27.08) and less ST (VI: b=j30.84; 95% CI,
j45.54 to j16.15; SD problems: b=j28.37; 95% CI,
j42.96 to j13.78) during PE. Similar differences in MVPA
and ST were not found for recess and lunchtime (Tables 5 and
6); boys with severe ID, however, were more sedentary dur-
ing lunchtime than boys with other disability types (Table 6).
Among girls, those with VI spent more time in MVPA (b=
15.49; 95% CI, 8.08–22.90) and less ST (b=j24.02; 95%
CI, j47.86 to j0.19) during PE lessons than those with se-
vere ID (Table 4). Similar to boys with severe ID, girls with
severe ID were more sedentary during lunchtime than girls
with other disability types (except moderate ID) (Table 6).
After adjusting for sex, BMI, grade level, and wear time,
results indicated that all three school settings contributed sig-
nificantly to both overall MVPA and ST during the school
day. Specifically, recess contributed significantly more to both
overall MVPA and ST than PE and lunchtime. Comparatively,
a 1-min increase in MVPA during recess (b= 1.24; 95% CI,
0.99 to 1.49) was associated with 1.24-min increase in daily
MVPA at school, whereas a 1-min increase during PE
(b= 1.11; 95% CI, 0.92 to 1.29) and lunchtime (b=1.04;
95% CI, 0.77 to 1.31) was associated with 1.11 and 1.04 min
increases, respectively. Similar findings were also obtained
for boys and girls, with recess being contributing the most to
overall MVPA (boys: b= 1.34; 95% CI, 1.02–1.66; girls:
TABLE 2. Time spent in MVPA and ST at school overall and in three specific settings.
Time Segment N
Duration (min)
Range (min)
%MVPA %ST
Mean Standard Deviation Mean Standard Deviation Mean Standard Deviation
Wearing time 259 412.7 46.6 126–603 4.2 3.4 70.0 13.1
PE lessons 178 54.9 18.3 30–95 13.2 12.4 49.4 24.2
Recess 247 31.6 10.7 15–55 9.4 11.1 49.5 24.2
Lunch time 246 65.2 12.8 40–90 4.5 6.2 69.0 17.2
Children wore accelerometers throughout the school day; only three school settings are reported in detail in this article.
TABLE 3. Comparison of MVPA (min) and ST (min) at school by sex across disability types.
MVPA (min) ST (min)
Coefficient 95% CI Coefficient 95% CI
Boys
BMI 0.24 j0.12 to 0.61 j0.99 j2.14 to 0.15
Grade level j0.07 j0.43 to 0.30 4.09 2.93 to 5.25
Total wearing time 0.09 0.06 to 0.13 0.57 0.47 to 0.67
Disability type (reference: ID-severe)
VI 7.69 j1.19 to 16.58 j28.58 j50.38 to j6.77
HI j1.01 j10.11 to 8.08 j39.35 j63.81 to j14.89
PD j2.03 j9.95 to 5.90 j24.83 j45.71 to j3.96
ID-mild 14.88 7.95 to 21.82 j72.20 j89.19 to j55.21
ID-moderate 13.29 5.98 to 20.59 j74.47 j92.12 to j56.82
SD problems 19.88 10.94 to 28.81 j79.45 j102.42 to j56.47
Girls
BMI 0.26 j0.10 to 0.63 j2.24 j4.01 to j0.48
Grade level j0.08 j0.48 to 0.32 3.40 1.47 to 5.31
Total wearing time 0.07 0.03 to 0.10 0.57 0.41 to 0.72
Disability type (reference: ID-severe)
VI 11.54 j4.28 to 27.37 j42.92 j80.73 to j5.11
HI j2.03 j17.20 to 13.13 j17.06 j56.54 to 22.42
PI 4.83 j8.55 to 18.21 j29.72 j63.50 to 4.07*
ID-mild 9.01 j3.01 to 21.04 j56.71 j86.40 to j27.01
ID-moderate 5.61 j6.39 to 17.62 j56.86 j88.15 to j25.56
Findings are presented as regression coefficients and 95% CI and were based on LMM with school as random effects and assessment days as a repeated-measure variable. The models
were adjusted for BMI, grade level, and total wearing time. Regression coefficients represent the difference in MVPA or ST in minutes, compared with the severe ID group. Statistically
significant results are in bold emphasis.
*0.05 GPG0.1.
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b= 1.05; 95% CI, 0.51–1.58), followed by PE (boys: b=
1.05; 95% CI, 0.82–1.29; girls: b= 1.02; 95% CI, 0.76–1.29),
and lunchtime (boys: b= 1.04; 95% CI, 0.60 to 1.49; girls:
b= 1.00; 95% CI, 0.69–1.32).
DISCUSSION
Given the important role of schools in promoting children"s
PA, the accurate identification and assessment of PA
opportunities conducive to increasing children"sPAis
critical to developing suitable school-based PA promotion
strategies (3,21). Children"s PA is greatly influenced by the
immediate environment, and in Hong Kong, it is the policy
that children with disabilities are educated in schools designed
to address specific disabilities. To investigate school settings
using the socioecological approach, this study is the first to
examine the accelerometer-assessed PA and ST of children
with different disability types across PE, recess, and lunch
periods in Hong Kong special schools while adjusting for
TABLE 4. Comparison of MVPA (min) and ST (min) during PE lessons in different types of special schools.
MVPA (min) ST (min)
Coefficient 95% CI Coefficient 95% CI
Boys
BMI j0.06 j0.31 to 0.19 0.03 j0.44 to 0.51
PE duration 0.04 j0.03 to 0.11 0.76 0.62 to 0.89
Grade level 0.02 j0.28 to 0.33 j0.31 j0.86 to 0.27
Disability type (reference: ID-severe)
VI 16.17 7.05 to 25.05 j30.84 j45.54 to j16.15
HI 0.31 j8.87 to 9.49 0.54 j14.37 to 15.45
PD 1.46 j7.63 to 10.54 j7.43 j22.01 to 7.14
ID-mild 6.90 j0.18 to 13.99* j9.62 j21.07 to 1.83*
ID-moderate 5.25 j1.89 to 12.39 j5.61 j17.19 to 5.97
SD problems 18.00 8.91 to 27.08 j28.37 j42.96 to j13.78
Girls
BMI j0.12 j0.39 to 0.16 0.01 j0.71 to 0.74
PE duration 0.00 j0.06 to 0.07 0.86 0.68 to 1.03
Grade level 0.25 j0.07 to 0.58 j0.46 j1.34 to 0.42
Disability type (reference: ID-severe)
VI 15.49 8.08 to 22.90 j24.02 j47.86 to j0.19
HI 0.28 j7.46 to 8.02 j2.32 j26.59 to 21.96
PD 5.67 j1.68 to 13.02 j15.18 j38.86 to 8.50
ID-mild 3.06 j2.78 to 8.90 j2.66 j21.26 to 15.94
ID-moderate 1.94 j3.94 to 7.82 j0.47 j19.18 to 18.24
Findings are presented as regression coefficients and 95% CI and were based on LMM with school as random effects and assessment days as a repeated-measure variable. The models
were adjusted for BMI, grade level, and duration of PE lessons. Regression coefficients represent the difference in MVPA or ST in minutes, compared with the severe ID group.
Statistically significant results are in bold emphasis.
*0.05 GPG0.1.
TABLE 5. Comparison of MVPA (min) and ST (min) during recess among different types
of special schools.
MVPA (min) ST (min)
Coefficient 95% CI Coefficient 95% CI
Boys
BMI j0.00 j0.11 to 0.11 j0.18 j0.37 to 0.01
Recess duration 0.16 j0.04 to 0.36 0.18 j0.00 to 0.37
Grade level j0.03 j0.14 to 0.08 0.32 j0.02 to 0.65
Disability type (reference: ID-severe)
VI 2.34 j7.34 to 12.01 j7.90 j24.06 to 8.26
HI j0.00 j9.66 to 9.66 j4.79 j20.09 to 10.52
PD j2.34 j12.16 to 7.47 3.74 j11.63 to 19.10
ID-mild 1.41 j6.90 to 9.72 j4.45 j17.84 to 8.94
ID-moderate 1.92 j6.41 to 10.24 j5.70 j19.10 to 7.70
Girls
BMI 0.08 j0.01 to 0.17 j0.14 j0.37 to 0.10
Recess duration 0.01 j0.06 to 0.08 0.32 0.06 to 0.57
Grade level j0.08 j0.17 to 0.02 0.53 0.28 to 0.78
Disability type (reference: ID-severe)
VI 2.50 0.01 to 5.01* j9.71 j19.73 to 0.30*
HI 0.65 j1.89 to 3.19 j3.83 j13.82 to 6.14
PD 2.78 j0.10 to 5.65* j3.41 j14.39 to 7.58
ID-mild 2.27 j0.16 to 4.70* j6.75 j15.98 to 2.48
ID-moderate 1.58 j0.85 to 4.00 j5.14 j14.39 to 4.11
Note: recess was reported in all schools except for social development problems (boys).
Findings are presented as regression coefficients and 95% CI and were based on LMM
with school as random effects and assessment days as a repeated-measure variable. The
models were adjusted for BMI, grade level, and recess duration. Regression coefficients
represent the difference in MVPA or ST in minutes, compared with the severe ID group.
Statistically significant results are in bold emphasis.
*0.05 GPG0.1.
TABLE 6. Comparison of MVPA (min) and ST (min) during lunch periods among different
types of special schools.
MVPA (min) ST (min)
Coefficient 95% CI Coefficient 95% CI
Boys
BMI 0.04 j0.07 to 0.16 j0.21 j0.50 to 0.08
Lunch time duration 0.04 j0.05 to 0.13 0.70 0.47 to 0.92
Grade level 0.16 0.04 to 0.27 j0.10 j0.39 to 0.18
Disability type (reference: ID-severe)
VI 4.52 0.74 to 8.30 j14.89 j24.24 to j5.55
HI 0.70 j3.11 to 4.50 j11.31 j20.73 to j1.90
PD 1.47 j1.83 to 4.77 j11.83 j20.00 to j3.65
ID-mild 3.75 0.82 to 6.68 j15.71 j22.96 to j8.47
ID-moderate 2.77 j0.24 to 5.78* j12.04 j19.47 to j4.60
Girls
BMI 0.05 j0.07 to 0.16 j0.40 j0.76 to j0.04
Lunch time duration 0.04 j0.05 to 0.13 0.65 0.44 to 0.85
Grade level 0.16 0.04 to 0.27 j0.18 j0.57 to 0.21
Disability type (reference: ID-severe)
VI 4.88 j90.77 to 100.53 j17.14 j24.75 to j9.52
HI 0.27 j23.83 to 27.38 j9.50 j17.38 to j1.63
PD 1.65 j36.09 to 39.39 j8.92 j15.58 to j2.26
ID-mild 2.33 j34.61 to 39.27 j11.77 j17.81 to j5.74
ID-moderate j0.54 j26.10 to 25.02 j5.35 j11.81 to 1.11
Findings are presented as regression coefficients and 95% CI and were based on LMM
with school as random effects and assessment days as a repeated-measure variable. The
models were adjusted for BMI, grade level, and lunch time duration. Regression co-
efficients represent the difference in MVPA or ST in minutes, compared with the severe
ID group. Statistically significant results are in bold emphasis.
*0.05 GPG0.1.
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potential confounders. In addition, we also examined the
relative contributions of these settings to children"soverall
MVPAandSTinschools.
Consistent with previous studies (19,30), the present in-
vestigation showed that children with disabilities accrued
little MVPA (about 17 min) during all day at school—an amount
far short of recommendations (14). Meanwhile, the children
spent more than 70% of their overall time at school being
sedentary. Despite small amounts of MVPA, children could pos-
sible reach PA recommendations if other school or off campus
PA opportunities were provided. After adjusting for con-
founding variables, all three school settings contributed statisti-
cally significant to children_s MVPA and ST at school. Recess,
however, contributed more MVPA than PE or lunchtime, con-
firming previous evidence that recess at school accommodates
more PA accrual than PE (12,30). Observations in these three
settings suggest there is potential for increasing the amount
PA provided there without increasing session length (e.g., via
improved management and provision of loose equipment).
Previous studies have shown that PA levels vary as a
function of both disability type and sex, with boys and
children with hidden disabilities (e.g., SD problems) being
more physically active than their counterparts (27,30). When
compared with the total daily MVPA and ST at school
across the disability types, boys with mild ID, moderate ID,
and SD problems were found to be more active than boys with
severe ID. The severity of disability relates to children"sPA
(27), and special schools that provide more social and envi-
ronmental support for PA are likely to promote more PA
(19,29). Meanwhile, children with severe ID, the least active
group, should be considered to be at a greater risk for de-
veloping chronic diseases associated with physical inactivity
and be a priority target group for PA interventions (16).
Children"s MVPA and ST differed across the three school
settings. During PE, boys with VI and SD problems had more
MVPA and less ST than boys with severe ID. Similarly, girls
with VI also had more MVPA and less ST than their female
peers with severe ID. Compared with those with other dis-
abilities, children with VI were found to be more active in
the present study, contrary to earlier Sit et al. (30) findings.
In Hong Kong, the special school for children with VI pro-
vides boarding facilities and specially adapted facilities and
educational services. It implements student-oriented teaching,
cross-level subject instruction, and individual education plans
that are embedded into the school-based curricula especially
designed to master the subjects and skill learning (8). It was
also interesting to find that boys with VI were more active
than their peers with severe ID during lunchtime. Determining
what is exactly done to promote activity accrual for children
with VI during PE and lunchtime periods in this school will
require further investigation.
We had originally planned to analyze the data for all struc-
tured PA programs on the campuses, including those provided
before/after school; schools, however, rarely provided PA
sessions other than during PE, recess, and lunchtime. Not only
did children have low MVPA and high ST across these
three settings, they accrued only about 17 MVPA minutes
throughout the school day. Thus, the entire school day
needs to be targeted for intervention, not just the three
specific settings. These interventions should focus on re-
placing ST with time spent moving, with higher intensity
PA more likely to lead to greater health benefits (14).
There are numerous strengths to the study, including
using accelerometry to objectively assess both the PA and ST
of children with disabilities while controlling for confounders;
separating the school day into three specific structured
settings; and the recruitment of a large sample size repre-
sentative of 22% of special school population in Hong
Kong. Study limitations include a cross-sectional nature
that prohibits detecting cause-and-effect relationships and
the sample being from special schools only. Children at-
tending mainstreamed/inclusive schools were not included,
thus reducing generalizability of the results. Additionally,
few structured before and after school PA programs and
active rehabilitation sessions at the 13 schools prohibited an
examination all the different possibilities where PA might
occur at schools.
To the best of our knowledge, this is the first study to
examine both the MVPA and ST of children among differ-
ent disability types using accelerometry at schools. Overall
children were very inactive at school, and an increase in
their PA is much needed. Intervention studies to increase
PA in schools among those with disabilities have not been
conducted in Hong Kong, but changes in the school physical
(e.g., increased play area usability and provision of equip-
ment) and social (e.g., teacher support for PA) setting offer
potential (13,20). We believe there is potential for the adap-
tation of evidence-based strategies shown to be effective with
children without disabilities to those with special needs (25).
Meanwhile, this segment of the population remains under-
researched relative to sedentary-related problems, and we
believe it should receive priority in the development and
assessment of cost-effective, feasible interventions to im-
prove their PA opportunities.
This studywas supported by the General Research Fund (GRF) from
the Research Grants Council (RGC) of the Government of the Hong
Kong Special Administrative Region, China (GRF752712). The third
author is supported by an Australian Research Council Future Fellow-
ship (FT 140100085). We declare that the results of the study are
presented clearly, honestly, and without fabrication, falsification, or
inappropriate data manipulation. The results do not constitute en-
dorsement by the American College of Sports Medicine. The authors
declare that they have no conflict of interest.
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