Table 3 compares the total daily MVPA and ST at school by sex across the disability types. After controlling for confounders, 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 differences 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 disability 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% confidence interval [CI], 7.05–25.05; SD problems: b = 18.00; 95% CI, 8.91–27.08) and less ST (VI: b = −30.84; 95% CI, −45.54 to −16.15; SD problems: b = −28.37; 95% CI, −42.96 to −13.78) 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 during 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 = −24.02; 95% CI, −47.86 to −0.19) during PE lessons than those with severe 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 significantly 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: 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).
Given the important role of schools in promoting children's PA, the accurate identification and assessment of PA opportunities conducive to increasing children's PA is 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 potential confounders. In addition, we also examined the relative contributions of these settings to children's overall MVPA and ST in schools.
Consistent with previous studies (19,30), the present investigation 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 possible reach PA recommendations if other school or off campus PA opportunities were provided. After adjusting for confounding variables, all three school settings contributed statistically significant to children’s MVPA and ST at school. Recess, however, contributed more MVPA than PE or lunchtime, confirming 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's PA (27), and special schools that provide more social and environmental 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 developing 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 disabilities, 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 provides 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 structured 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 replacing 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 representative 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 attending 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 different 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 equipment) and social (e.g., teacher support for PA) setting offer potential (13,20). We believe there is potential for the adaptation 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 improve their PA opportunities.
This study was 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 Fellowship (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 endorsement by the American College of Sports Medicine. The authors declare that they have no conflict of interest.
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Keywords:© 2017 American College of Sports Medicine
ACCELEROMETER; HEALTH; YOUTH; SPECIAL NEEDS; RECESS; PHYSICAL EDUCATION