Exercise in Children with Disabilities

  • Sherilyn W. DriscollEmail author
  • Erin M. Conlee
  • Joline E. Brandenburg
  • Bradford W. Landry
  • Amy E. Rabatin
  • Cara C. Prideaux
  • Edward R. Laskowski
Pediatric Rehabilitation Medicine (A Houtrow and M Fuentes, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Pediatric Rehabilitation Medicine


Purpose of Review

The goal of this paper is to review the role and importance of exercise in the overall health and fitness of children with disabilities and to identify unique considerations in specific populations.

Recent Findings

Exercise and activity are known to be of critical importance to the health and well-being of typically developing children and adolescents. Children with disabling conditions are not immune to the obesity epidemic and even less likely to participate in structured or recreational activities than their typically developing peers. Although barriers to participation exist, studies largely support the same physiologic benefits of exercise in children with medical conditions and disabilities as those without. Providers must be aware of exercise precautions and restrictions specific to children with certain diagnoses. Furthermore, children with disabilities may need additional supports, accommodations, and individualization to facilitate participation. Future research should address activity guidelines for children with specific diagnoses as well as means of engaging children and adolescents with disabilities to participate in exercise.


Physical activity and exercise have been proven to be beneficial, safe, and effective for children and adolescents with disabilities, though some individuals will require special precautions for safety or adaptations to permit participation.


Exercise Children Disability Adaptive sports Precautions Physical activity 


Compliance with Ethical Standards

Conflict of Interest

Sherilyn Driscoll, Erin Conlee, Joline Brandenburg, Bradford Landry, Amy Rabatin, Cara Prideaux and Edward Laskowski declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Janssen I, Leblanc AG. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Act. 2010;7:40.Google Scholar
  2. 2.
    Foley S, Quinn S, Dwyer T, Venn A, Jones G. Measures of childhood fitness and body mass index are associated with bone mass in adulthood: a 20-year prospective study. J Bone Miner Res. 2008;23:994–1001.Google Scholar
  3. 3.
    Moreira C, Santos R, de Farias Júnior JC, Vale S, Santos PC, Soares-Miranda L, et al. Metabolic risk factors, physical activity and physical fitness in Azorean adolescents: a cross-sectional study. BMC Public Health. 2011;11:214.Google Scholar
  4. 4.
    Simmons RK, Griffin SJ, Steele R, Wareham NJ, Ekelund U, On behalf of the ProActive Research Team. Increasing overall physical activity and aerobic fitness is associated with improvements in metabolic risk: cohort analysis of the ProActive trial. Diabetologia. 2008;51:787–94.Google Scholar
  5. 5.
    Stabelini Neto A, Sasaki JE, Mascarenhas LP, et al. Physical activity, cardiorespiratory fitness, and metabolic syndrome in adolescents: a cross-sectional study. BMC Public Health. 2011;11:674.Google Scholar
  6. 6.
    Ruiz JR OF, Martínez-Gómez D, Labayen I. Objectively measured physical activity and sedentary time in European adolescents: the HELENA study. Am J Epidemiol. 2011;174:173–84.Google Scholar
  7. 7.
    •• US Department of Health and Human Services. Healthy People 2020. Accessed April 14, 2018. 80% of adolescents in the USA do not meet activity recommendations for youth outlined in The Physical Activity Guidelines for Americans.
  8. 8.
    Mitchell JA, Pate RR, Beets MW. Time spent in sedentary behavior and changes in childhood BMI: a longitudinal study from ages 9 to 15 years. Int J Obes. 2013;37:54–60.Google Scholar
  9. 9.
    Fryar CD, Carroll MD and Ogden CL. Prevalence of overweight and obesity among children and adolescents: United States, 1963-1965 through 2011-2012. Health E-Stats 2014.Google Scholar
  10. 10.
    • Skinner AC, Ravanbakht SN, Skelton JA, et al. Prevalence of obesity and severe obesity in US children, 1999-2016. Pediatrics. 2018;141:e20173459 This study provides updated prevalence data on obesity in youth and highlights the upward trend in obesity, particulalry in preschool age children. Google Scholar
  11. 11.
    Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med. 1997 Sep 25;337:869–73.Google Scholar
  12. 12.
    •• Freedman DS, Dietz WH, Srinivasan SR, et al. The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics. 1999;103:1175–82 A large community-based study determined that obesity during childhood and adolescence correlates with an increased likelihood of several risk factors related to cardiovascular disease later in life. They emphasized the importance of prevention and treatment of obesity in youth.Google Scholar
  13. 13.
    Maher CA, Williams MT, Olds T, Lane AE. Physical and sedentary activity in adolescents with cerebral palsy. Dev Med Child Neurol. 2007;49(6):450–7.Google Scholar
  14. 14.
    Frey GC, Stanish HI, Temple VA. Physical activity of youth with intellectual disability: review and research agenda. Adapt Phys Act Q. 2008;25(2):95–117.Google Scholar
  15. 15.
    Carlon SL, Taylor NF, Dodd KJ, Shields N. Differences in habitual physical activity levels of young people with cerebral palsy and their typically developing peers: a systematic review. Disabil Rehabil. 2013;35(8):647–55.Google Scholar
  16. 16.
    Shields N, Synnot AJ, Barr M. Perceived barriers and facilitators to physical activity for children with disability: a systematic review. Br J Sports Med. 2012;46(14):989–97.Google Scholar
  17. 17.
    Verschuren O, Wiart L, Hermans D, Ketelaar M. Identification of facilitators and barriers to physical activity in children and adolescents with cerebral palsy. J Pediatr. 2012;161(3):488–94.Google Scholar
  18. 18.
    Rimmer JH, Schiller W, Chen MD. Effects of disability-associated low energy expenditure deconditioning syndrome. Exerc Sport Sci Rev. 2012;40(1):22–9.Google Scholar
  19. 19.
    Cremer N, Hurvitz EA, Peterson MD. Multimorbidity in middle-aged adults with cerebral palsy. Am J Med. 2017;130(6):744 e9–744 e15.Google Scholar
  20. 20.
    Peterson MD, Ryan JM, Hurvitz EA, Mahmoudi E. Chronic conditions in adults with cerebral palsy. JAMA. 2015;314(21):2303–5.Google Scholar
  21. 21.
    •• US Department of Health and Human Services. Physical Activity Guideline for Americans. ODPHP Publication No. U0036. Office of Disease Prevention and Health Promotion. Accessed April 14, 2018. 2008. The Physical Activity Guidelines for Americans is an evidence based set of recommendations meant to improve health updated in 2018.
  22. 22.
    •• Verschuren O, Peterson MD, Balemans AC, Hurvitz EA. Exercise and physical activity recommendations for people with cerebral palsy. Dev Med Child Neurol. 2016;58:798–808 This is one of the few diagnosis specific sets of activity recommendations for youth and the first guideline for activity in cerebral palsy. Google Scholar
  23. 23.
    McCrory P, et al. Consensus statement on concussion in sport-the 5(th) international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838–47.Google Scholar
  24. 24.
    Thomas DG, Apps JN, Hoffmann RG, McCrea M, Hammeke T. Benefits of strict rest after acute concussion: a randomized controlled trial. Pediatrics. 2015;135:213–23.Google Scholar
  25. 25.
    Mossberg KA, Ayala D, Baker T, Heard J, Masel B. Aerobic capacity after traumatic brain injury: comparison with a nondisabled cohort. Arch Phys Med Rehabil. 2007;88:315–20.Google Scholar
  26. 26.
    Kreber LA, Griesbach GS. The interplay between neuropathology and activity based rehabilitation after traumatic brain injury. Brain Res. 1640;2016:152–63.Google Scholar
  27. 27.
    Chin LM, Chan L, Woolstenhulme JG, Christensen EJ, Shenouda CN, Keyser RE. Improved cardiorespiratory fitness with aerobic exercise training in individuals with traumatic brain injury. J Head Trauma Rehabil. 2015;30:382–90.Google Scholar
  28. 28.
    Chin LM, Keyser RE, Dsurney J, Chan L. Improved cognitive performance following aerobic exercise training in people with traumatic brain injury. Arch Phys Med Rehabil. 2015;96:754–9.Google Scholar
  29. 29.
    Wise EK, Hoffman JM, Powell JM, Bombardier CH, Bell KR. Benefits of exercise maintenance after traumatic brain injury. Arch Phys Med Rehabil. 2012;93:1319–23.Google Scholar
  30. 30.
    Bailes JE, Cantu RC. Head injury in athletes. Neurosurgery. 2001;48:26–45 discussion 45-26.Google Scholar
  31. 31.
    Miele VJ, Bailes JE, Martin NA. Participation in contact or collision sports in athletes with epilepsy, genetic risk factors, structural brain lesions, or history of craniotomy. Neurosurg Focus. 2006;21(4):E9.Google Scholar
  32. 32.
    Blount JP, Severson M, Atkins V, Tubbs RS, Smyth MD, Wellons JC, et al. Sports and pediatric cerebrospinal fluid shunts: who can play? Neurosurgery. 2004;54(5):1190–6 discussion 1196-8.Google Scholar
  33. 33.
    Hydrocephalus Association. Sports and pediatric cerebrospinal fluid shunts: who can play? 2004; Accessed February 21, 2018.
  34. 34.
    van den Berg-Emons RJ, Bussmann JB, Stam HJ. Accelerometry-based activity spectrum in persons with chronic physical conditions. Arch Phys Med Rehabil. 2010;91(12):1856–61.Google Scholar
  35. 35.
    Crytzer TM, Dicianno BE, Kapoor R. Physical activity, exercise, and health-related measures of fitness in adults with spina bifida: a review of the literature. PM R. 2013;5(12):1051–62.Google Scholar
  36. 36.
    Johnston TE, McDonald CM. Health and fitness in pediatric spinal cord injury: medical issues and the role of exercise. J Pediatr Rehabil Med. 2013;6(1):35–44.Google Scholar
  37. 37.
    Oliveira A, Jacome C, Marques A. Physical fitness and exercise training on individuals with spina bifida: a systematic review. Res Dev Disabil. 2014;35(5):1119–36.Google Scholar
  38. 38.
    Klaas SJ, Kelly EH, Gorzkowski J, Homko E, Vogel LC. Assessing patterns of participation and enjoyment in children with spinal cord injury. Dev Med Child Neurol. 2010;52(5):468–74.Google Scholar
  39. 39.
    Tweedy SM, Beckman EM, Geraghty TJ, Theisen D, Perret C, Harvey LA, et al. Exercise and sports science Australia (ESSA) position statement on exercise and spinal cord injury. J Sci Med Sport. 2017;20(2):108–15.Google Scholar
  40. 40.
    Bloemen MA, Verschuren O, van Mechelen C, Borst HE, de Leeuw AJ, van der Hoef M, et al. Personal and environmental factors to consider when aiming to improve participation in physical activity in children with spina bifida: a qualitative study. BMC Neurol. 2015;15:11.Google Scholar
  41. 41.
    • Evans N, et al. Exercise recommendations and considerations for persons with spinal cord injury. Arch Phys Med Rehabil. 2015;96(9):1749–50 Specific exercise recommendations are offered for adults with spinal cord injury. Google Scholar
  42. 42.
    Nightingale TE, Metcalfe RS, Vollaard NB, Bilzon JL. Exercise guidelines to promote cardiometabolic health in spinal cord injured humans: time to raise the intensity? Arch Phys Med Rehabil. 2017;98(8):1693–704.Google Scholar
  43. 43.
    • Anziska Y, Inan S. Exercise in neuromuscular disease. Semin Neurol. 2014;34(5):542–56 Although not specific to children, the authors review exercise recommendations and precautions in a variety of childhood onset diagnsoses. Google Scholar
  44. 44.
    Birnkrant DJ, Bushby K, Bann CM, Apkon SD, Blackwell A, Brumbaugh D, et al. Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and neuromuscular, rehabilitation, endocrine, and gastrointestinal and nutritional management. Lancet Neurol. 2018;17(3):251–67.Google Scholar
  45. 45.
    Hart R, Ballaz L, Robert M, Pouliot A, D’Arcy S, Raison M, et al. Impact of exercise-induced fatigue on the strength, postural control, and gait of children with a neuromuscular disease. Am J Phys Med Rehabil. 2014;93(8):649–55.Google Scholar
  46. 46.
    Habers GE, et al. Muscles in motion: a randomized controlled trial on the feasibility, safety and efficacy of an exercise training programme in children and adolescents with juvenile dermatomyositis. Rheumatology (Oxford). 2016;55(7):1251–62.Google Scholar
  47. 47.
    Sman AD, Hackett D, Fiatarone Singh M, Fornusek C, Menezes MP, Burns J. Systematic review of exercise for Charcot-Marie-Tooth disease. J Peripher Nerv Syst. 2015;20(4):347–62.Google Scholar
  48. 48.
    Lewelt A, Krosschell KJ, Stoddard GJ, Weng C, Xue M, Marcus RL, et al. Resistance strength training exercise in children with spinal muscular atrophy. Muscle Nerve. 2015;52(4):559–67.Google Scholar
  49. 49.
    Klenck C, Gebke K. Practical management: common medical problems in disabled athletes. Clin J Sport Med. 2007;17(1):55–60.Google Scholar
  50. 50.
    Patel DR, Greydanus DE. Sport participation by physically and cognitively challenged young athletes. Pediatr Clin N Am. 2010;57(3):795–817.Google Scholar
  51. 51.
    Wilson PE, Washington RL. Pediatric wheelchair athletics: sports injuries and prevention. Paraplegia. 1993;31(5):330–7.Google Scholar
  52. 52.
    Wind WM, Schwend RM, Larson J. Sports for the physically challenged child. J Am Acad Orthop Surg. 2004;12(2):126–37.Google Scholar
  53. 53.
    Long AR, Rouster-Stevens KA. The role of exercise therapy in the management of juvenile idiopathic arthritis. Curr Opin Rheumatol. 2010;22(2):213–7.Google Scholar
  54. 54.
    Van Brussel M, et al. Physical training in children with osteogenesis imperfecta. J Pediatr. 2008;152(1):111–6 116.e1.Google Scholar
  55. 55.
    Montpetit K, Dahan-Oliel N, Ruck-Gibis J, Fassier F, Rauch F, Glorieux F. Activities and participation in young adults with osteogenesis imperfecta. J Pediatr Rehabil Med. 2011;4(1):13–22.Google Scholar
  56. 56.
    Schroeder EL, Lavallee ME. Ehlers-Danlos syndrome in athletes. Curr Sports Med Rep. 2006;5(6):327–34.Google Scholar
  57. 57.
    Rombaut L, Malfait F, Cools A, de Paepe A, Calders P. Musculoskeletal complaints, physical activity and health-related quality of life among patients with the Ehlers-Danlos syndrome hypermobility type. Disabil Rehabil. 2010;32(16):1339–45.Google Scholar
  58. 58.
    Frohlich L, Wesley A, Wallen M, Bundy A. Effects of neoprene wrist/hand splints on handwriting for students with joint hypermobility syndrome: a single system design study. Phys Occup Ther Pediatr. 2012;32(3):243–55.Google Scholar
  59. 59.
    Busch AJ, et al. Resistance exercise training for fibromyalgia. Cochrane Database Syst Rev 2013;(12):Cd010884.Google Scholar
  60. 60.
    Mikkelsson M, Salminen JJ, Kautiainen H. Non-specific musculoskeletal pain in preadolescents. Prevalence and 1-year persistence. Pain. 1997;73(1):29–35.Google Scholar
  61. 61.
    Perquin CW, Hazebroek-Kampschreur AA, Hunfeld JA, et al. Pain in children and adolescents: a common experience. Pain. 2000;87:51–8.Google Scholar
  62. 62.
    King S, Chambers CT, Huguet A, MacNevin RC, McGrath PJ, Parker L, et al. The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain. 2011;152(12):2729–38.Google Scholar
  63. 63.
    Kennedy J, et al. Prevalence of persistent pain in the U.S. adult population: new data from the 2010 national health interview survey. J Pain. 2014;15(10):979–84.Google Scholar
  64. 64.
    Ehde DM, Jensen MP, Engel JM, Turner JA, Hoffman AJ, Cardenas DD. Chronic pain secondary to disability: a review. Clin J Pain. 2003;19(1):3–17.Google Scholar
  65. 65.
    Miro J, et al. Pain extent and function in youth with physical disabilities. J Pain Res. 2017;10:113–20.Google Scholar
  66. 66.
    de la Vega R, et al. Chronic pain prevalence and associated factors in adolescents with and without physical disabilities. Dev Med Child Neurol 2018.Google Scholar
  67. 67.
    Pons T, et al. Potential risk factors for the onset of complex regional pain syndrome type 1: a systematic literature review. Anesthesiol Res Pract. 2015;2015:956539.Google Scholar
  68. 68.
    Engel JM, Wilson S, Tran ST, Jensen MP, Ciol MA. Pain catastrophizing in youths with physical disabilities and chronic pain. J Pediatr Psychol. 2013;38(2):192–201.Google Scholar
  69. 69.
    Asih S, Neblett R, Mayer TG, Brede E, Gatchel RJ. Insomnia in a chronic musculoskeletal pain with disability population is independent of pain and depression. Spine J. 2014;14(9):2000–7.Google Scholar
  70. 70.
    Sherry DD, Weisman R. Psychologic aspects of childhood reflex neurovascular dystrophy. Pediatrics. 1988;81(4):572–8.Google Scholar
  71. 71.
    Silber TJ. Eating disorders and reflex sympathetic dystrophy syndrome: is there a common pathway? Med Hypotheses. 1997;48(3):197–200.Google Scholar
  72. 72.
    Landry BW, Fischer PR, Driscoll SW, Koch KM, Harbeck-Weber C, Mack KJ, et al. Managing chronic pain in children and adolescents: a clinical review. PM R. 2015;7(11 Suppl):S295–315.Google Scholar
  73. 73.
    Pitetti K, Baynard T, Agiovlasitis S. Children and adolescents with down syndrome, physical fitness and physical activity. J Sport Health Sci. 2013;2(1):47–57.Google Scholar
  74. 74.
    Hankinson TC, Anderson RC. Craniovertebral junction abnormalities in down syndrome. Neurosurgery. 2010;66(3 Suppl):32–8.Google Scholar
  75. 75.
    Parikh S, Goldstein A, Koenig MK, Scaglia F, Enns GM, Saneto R, et al. Diagnosis and management of mitochondrial disease: a consensus statement from the Mitochondrial Medicine Society. Genet Med. 2015;17(9):689–701.Google Scholar
  76. 76.
    Smith MA, Altekruse SF, Adamson PC, Reaman GH, Seibel NL. Declining childhood and adolescent cancer mortality. Cancer. 2014;120(16):2497–506.Google Scholar
  77. 77.
    Barnea D, Raghunathan N, Friedman DN, Tonorezos ES. Obesity and metabolic disease after childhood cancer. Oncology (Williston Park). 2015;29(11):849–55.Google Scholar
  78. 78.
    Devine KA, Mertens AC, Whitton JA, Wilson CL, Ness KK, Gilleland Marchak J, et al. Factors associated with physical activity among adolescent and young adult survivors of early childhood cancer: a report from the childhood cancer survivor study (CCSS). Psychooncology. 2018;27(2):613–9.Google Scholar
  79. 79.
    Ross WL, le A, Zheng DJ, Mitchell HR, Rotatori J, Li F, et al. Physical activity barriers, preferences, and beliefs in childhood cancer patients. Support Care Cancer. 2018;26:2177–84.Google Scholar
  80. 80.
    Baumann FT, Bloch W, Beulertz J. Clinical exercise interventions in pediatric oncology: a systematic review. Pediatr Res. 2013;74(4):366–74.Google Scholar
  81. 81.
    Braam KI, et al. Physical exercise training interventions for children and young adults during and after treatment for childhood cancer. Cochrane Database Syst Rev. 2016;3:CD008796.Google Scholar
  82. 82.
    Kavey RE, et al. Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American Heart Association Expert Panel on Population and Prevention Science; the Councils on Cardiovascular Disease in the Young, Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism, High Blood Pressure Research, Cardiovascular Nursing, and the Kidney in Heart Disease; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation. 2006;114(24):2710–38.Google Scholar
  83. 83.
    Group, C.s.O Long-term follow-up guidelines for survivors of childhood, adolescent and young adult cancers (Version 4.0). 2013, Children's Oncology Group.Google Scholar
  84. 84.
    Okada M, Meeske KA, Menteer J, Freyer DR. Exercise recommendations for childhood cancer survivors exposed to cardiotoxic therapies: an institutional clinical practice initiative. J Pediatr Oncol Nurs. 2012;29(5):246–52.Google Scholar
  85. 85.
    Okada M, Hockenberry MJ, Koh CJ, Meeske KA, Rangan KE, Rodgers C, et al. Reconsidering physical activity restrictions for mononephric survivors of childhood cancer: a report from the Children's Oncology Group. J Pediatr Oncol Nurs. 2016;33(4):306–13.Google Scholar
  86. 86.
    Manco-Johnson MJ, Abshire TC, Shapiro AD, Riske B, Hacker MR, Kilcoyne R, et al. Prophylaxis versus episodic treatment to prevent joint disease in boys with severe hemophilia. N Engl J Med. 2007;357(6):535–44.Google Scholar
  87. 87.
    Martin C, Pialoux V, Faes C, Charrin E, Skinner S, Connes P. Does physical activity increase or decrease the risk of sickle cell disease complications? Br J Sports Med. 2018;52(4):214–8.Google Scholar
  88. 88.
    Eichner ER. Sickle cell trait in sports. Curr Sports Med Rep. 2010;9(6):347–51.Google Scholar
  89. 89.
    Baker AM, Levine TB, Goldberg AD, Levine AB. Natural history and predictors of obesity after orthotopic heart transplantation. J Heart Lung Transplant. 1992;11(6):1156–9.Google Scholar
  90. 90.
    Clark CG, Cantell M, Crawford S, Hamiwka LA. Accelerometry-based physical activity and exercise capacity in pediatric kidney transplant patients. Pediatr Nephrol. 2012;27(4):659–65.Google Scholar
  91. 91.
    Nobili V, de Ville de Goyet J. Pediatric post-transplant metabolic syndrome: new clouds on the horizon. Pediatr Transplant. 2013;17(3):216–23.Google Scholar
  92. 92.
    Vandekerckhove K, et al. Evaluation of exercise performance, cardiac function, and quality of life in children after liver transplantation. Transplantation. 2016;100(7):1525–31.Google Scholar
  93. 93.
    Wolf MF, George RP, Warshaw B, Wang E, Greenbaum LA. Physical activity and kidney injury in pediatric and young adult kidney transplant recipients. J Pediatr. 2016;179:90–5 e2.Google Scholar
  94. 94.
    Didsbury M, McGee RG, Tong A, Craig JC, Chapman JR, Chadban S, et al. Exercise training in solid organ transplant recipients: a systematic review and meta-analysis. Transplantation. 2013;95(5):679–87.Google Scholar
  95. 95.
    Borg G. Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med. 1970;2(2):92–8.Google Scholar
  96. 96.
    Singh TP, Gauvreau K, Rhodes J, Blume ED. Longitudinal changes in heart rate recovery after maximal exercise in pediatric heart transplant recipients: evidence of autonomic re-innervation? J Heart Lung Transplant. 2007;26(12):1306–12.Google Scholar
  97. 97.
    Vanderlaan RD, Conway J, Manlhiot C, McCrindle BW, Dipchand AI. Enhanced exercise performance and survival associated with evidence of autonomic reinnervation in pediatric heart transplant recipients. Am J Transplant. 2012;12(8):2157–63.Google Scholar
  98. 98.
    •• Americans with Disabilities Fund: Rx for Exercise, Pediatrics. 2018. Available from: Accessed May 31, 2018. The Foundation for PM&R provides a free exercise prescription pad in order to encourage physicians to think about and prescribe exercise as medicine to their patients.
  99. 99.
    Lobelo F, Duperly J, Frank E. Physical activity habits of doctors and medical students influence their counselling practices. Br J Sports Med. 2009;43(2):89–92.Google Scholar
  100. 100.
    Wee CC, McCarthy E, Davis RB, Phillips RS. Physician counseling about exercise. Jama. 1999;282(16):1583–8.Google Scholar
  101. 101.
    • O'Brien TD, et al. Systematic review of physical activity and exercise interventions to improve health, fitness and well-being of children and young people who use wheelchairs. BMJ Open Sport Exerc Med. 2016;2(1):e000109 Children who use wheelchairs were found to be able to participate in exercise safely and derive similar benefits as able-bodied children. Google Scholar
  102. 102.
    Mizrahi D, Wakefield CE, Fardell JE, Quinn VF, Lim Q, Clifford BK, et al. Distance-delivered physical activity interventions for childhood cancer survivors: a systematic review and meta-analysis. Crit Rev Oncol Hematol. 2017;118:27–41.Google Scholar
  103. 103.
    Anaby DR, Law M, Feldman D, Majnemer A, Avery L. The effectiveness of the pathways and resources for engagement and participation (PREP) intervention: improving participation of adolescents with physical disabilities. Dev Med Child Neurol. 2018;60(5):513–9.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Sherilyn W. Driscoll
    • 1
    Email author
  • Erin M. Conlee
    • 1
  • Joline E. Brandenburg
    • 1
  • Bradford W. Landry
    • 1
  • Amy E. Rabatin
    • 1
  • Cara C. Prideaux
    • 2
  • Edward R. Laskowski
    • 2
  1. 1.Mayo Clinic Children’s CenterRochesterUSA
  2. 2.Mayo ClinicRochesterUSA

Personalised recommendations