Sports: An underutilized tool for patients with disabilities
Sport activities promote health and well-being in this population, which is disproportionately affected by obesity, sedentary lifestyle, and social isolation.
PRACTICE RECOMMENDATIONS
› Recommend physical activity as an adjunct to traditional medical management to maximize physical and psychosocial benefits in patients with intellectual/developmental disabilities. B
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Special considerations. Patients with cerebral palsy have a heightened risk for depression and anxiety.19 Mental health can be assessed via the General Anxiety Disorder-7, the Patient Health Questionnaire-9, and the Ask Suicide-Screening Questions tools, among others. Mental health screening may need to be adjusted depending on the patient’s level of cognition and ability to communicate. The patient’s caregiver also can provide supplemental information.
Consider screening vitamin D levels in patients with cerebral palsy. Approximately 50% of adults with cerebral palsy are vitamin D–deficient secondary to sedentary behavior and lack of sun exposure.20-22
Optimal medical management has been shown to decrease muscle spasticity and may be beneficial before initiating an exercise program. For patients with moderate-to-severe symptoms, referral for physical therapy to further improve gross motor function and spasticity may be required before initiating an exercise program.
Which exercise? Individuals with cerebral palsy spend 76% to 99% of their waking hours being sedentary.5 Consequently, they typically have decreased cardiorespiratory endurance and decreased muscle strength. Strength training may improve muscle spasticity, gross motor function, joint health, and respiratory insufficiency.5 Even in those who function at Level IV-V of the Gross Motor Function Classification system, exercise reduces vertebral fractures and improves time spent standing.23 By improving endurance, spasticity, and strength with exercise, deconditioning can be mitigated.
Involvement in sports promotes peer interactions, personal interests, and positive self-identity. It can give a newfound passion for life. Additionally, families of children with disabilities who engage in leisure activities together have less caregiver burden.24,25 Sporting activities offer a way to optimize psychosocial well-being for the patient and the entire family.
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