Barriers to Physical Activity among Children and Adolescents with Intellectual Disabilities: A Cross-sectional Study

WANG Yu JIN Qiu Meng WANG Chao HE Gang LI Dong Sheng MA Kai Yue

WANG Yu, JIN Qiu Meng, WANG Chao, HE Gang, LI Dong Sheng, MA Kai Yue. Barriers to Physical Activity among Children and Adolescents with Intellectual Disabilities: A Cross-sectional Study[J]. Biomedical and Environmental Sciences, 2023, 36(12): 1177-1182. doi: 10.3967/bes2023.154
Citation: WANG Yu, JIN Qiu Meng, WANG Chao, HE Gang, LI Dong Sheng, MA Kai Yue. Barriers to Physical Activity among Children and Adolescents with Intellectual Disabilities: A Cross-sectional Study[J]. Biomedical and Environmental Sciences, 2023, 36(12): 1177-1182. doi: 10.3967/bes2023.154

doi: 10.3967/bes2023.154

Barriers to Physical Activity among Children and Adolescents with Intellectual Disabilities: A Cross-sectional Study

Funds: This study was supported by the Beijing Social Science Foundation [No. 16YTC038].
More Information
    Author Bio:

    WANG Yu, male, born in 1991, MD, majoring in the physical activity of children

    JIN Qiu Meng, female, born in 1993, MD, majoring in the physical activity of children

    Corresponding author: WANG Chao, PhD, Associate Professor, Tel: 86-10-82099206, E-mail: wangchao@cupes.edu.cn
  • The authors declare no conflict of interest.
  • &These authors contributed equally to this work.
  • The authors declare no conflict of interest.
    &These authors contributed equally to this work.
    注释:
    1) Conflicts of Interest:
  • Table  1.   Participants’ characteristics (mean ± SD)

    VariablesTotal (n = 42)Boys (n = 28)Girls (n = 14)
    Age (year)11.45 ± 2.8211.64 ± 2.8811.07 ± 2.76
    Height (cm)145.87 ± 16.54149.23 ± 18.05a139.14 ± 10.64
    Weight (kg)46.49 ± 21.9650.87 ± 23.4837.73 ± 15.86
    BMI (kg/m2)20.89 ± 6.4521.85 ± 6.6818.97 ± 5.71
    IQ score (point)64.90 ± 13.7067.04 ± 14.3560.64 ± 11.61
    PA (min/day)
     Average daily
      LPA137.34 ± 41.20142.53 ± 45.54126.95 ± 29.52
      MPA26.83 ± 12.0528.07 ± 11.9224.36 ± 12.37
      VPA28.54 ± 13.2229.72 ± 14.7226.18 ± 9.58
      MVPA55.37 ± 21.9557.79 ± 22.8050.54 ± 20.04
      TPA192.71 ± 51.72200.32 ± 53.78177.49 ± 45.35
     Weekday
      LPA136.56 ± 40.22141.84 ± 44.59125.99 ± 28.15
      MPA27.58 ± 13.3229.02 ± 13.2424.69 ± 13.49
      VPA30.23 ± 14.9131.29 ± 15.8928.11 ± 13.01
      MVPA57.81 ± 24.9260.31 ± 25.0552.81 ± 24.80
      TPA194.36 ± 52.07202.14 ± 54.13178.79 ± 45.54
     Weekend
      LPA145.29 ± 57.71150.03 ± 62.16135.83 ± 48.32
      MPA27.15 ± 18.4627.97 ± 20.5725.51 ± 13.84
      VPA26.89 ± 15.6228.00 ± 17.5324.69 ± 11.08
      MVPA54.05 ± 30.6955.97 ± 34.2650.19 ± 22.56
      TPA199.34 ± 77.55206.00 ± 82.15186.02 ± 68.28
     In-school
      LPA46.15 ± 15.5946.17 ± 13.8546.10 ± 16.51
      MPA10.00 ± 5.4910.46 ± 5.629.11 ± 5.32
      VPA11.48 ± 5.6111.56 ± 5.5311.32 ± 5.99
      MVPA21.49 ± 10.1422.02 ± 10.1220.42 ± 10.46
      TPA67.64 ± 19.9768.19 ± 18.0966.52 ± 24.00
     Out-of-school
      LPA71.97 ± 24.33b76.70 ± 27.17a c62.50 ± 13.76d
      MPA13.81 ± 7.02b14.96 ± 7.44c11.53 ± 5.64
      VPA15.08 ± 9.73b16.14 ± 11.07c12.96 ± 6.06
      MVPA28.90 ± 14.83b31.10 ± 16.06c24.49 ± 11.24
      TPA100.86 ± 32.47b107.80 ± 34.70a c86.99 ± 22.68d
    PA barriers (point)
     Learning ability2.98 ± 1.133.17 ± 1.152.62 ± 1.05
     Others’ discriminatory attitude2.99 ± 1.393.17 ± 1.282.64 ± 1.57
     Physical condition2.29 ± 1.032.30 ± 0.912.27 ±1.26
     Parents’ behaviour and attitude2.83 ± 1.092.86 ± 1.042.79 ± 1.22
     Psychological characteristics2.39 ± 1.182.55 ± 1.182.07 ± 1.14
    Total score of barriers13.49 ± 4.0214.05 ± 3.7412.39 ± 4.45
      Note. LPA: light physical activity; MPA: moderate physical activity; VPA: vigorous physical activity; MVPA: moderate-to-vigorous physical activity; TPA: total physical activity; aP < 0.05, compared with girls; bP < 0.05, compared with in-school PA in all participants; cP < 0.05, compared with in-school PA in boys; dP < 0.05, compared with in-school PA in girls.
    下载: 导出CSV

    Table  2.   Results of regression analysis of PA and their barriers for participants

    Variables Total Boys Girls
    β P β P β P
    Average daily VPA
    Learning ability −0.120 0.548 −0.223 0.358 −0.130 0.720
    Others’ discriminatory attitude −0.156 0.476 −0.110 0.644 0.525 0.378
    Physical condition −0.008 0.962 0.021 0.921 −0.233 0.537
    Parents’ behaviour and attitude 0.307 0.142 0.534 0.032 −0.983 0.135
    Psychological characteristics 0.008 0.969 −0.045 0.851 0.352 0.397
    R2 0.104 0.275 0.558
    Weekday MPA
    Learning ability −0.040 0.831 −0.112 0.649 −0.178 0.558
    Others’ discriminatory attitude −0.003 0.989 −0.094 0.698 1.163 0.044
    Physical condition 0.012 0.943 0.019 0.930 −0.316 0.326
    Parents’ behaviour and attitude −0.114 0.559 0.117 0.625 −1.611 0.014
    Psychological characteristics 0.056 0.770 −0.032 0.895 0.582 0.119
    R2 0.203 0.251 0.696
    Weekday VPA
    Learning ability −0.134 0.511 −0.285 0.256 −0.035 0.916
    Others’ discriminatory attitude −0.113 0.612 −0.111 0.651 0.831 0.152
    Physical condition 0.015 0.937 0.065 0.764 −0.314 0.374
    Parents’ behaviour and attitude 0.209 0.325 0.468 0.064 −1.346 0.042
    Psychological characteristics 0.036 0.860 0.052 0.834 0.304 0.423
    R2 0.062 0.232 0.627
    Weekday MVPA
    Learning ability −0.101 0.615 −0.240 0.356 −0.115 0.689
    Others’ discriminatory attitude −0.069 0.754 −0.120 0.638 1.069 0.050
    Physical condition 0.015 0.934 0.051 0.820 −0.337 0.279
    Parents’ behaviour and attitude 0.064 0.759 0.359 0.164 −1.582 0.013
    Psychological characteristics 0.052 0.802 0.016 0.951 0.476 0.171
    R2 0.080 0.170 0.721
    Weekend VPA
    Learning ability 0.060 0.745 0.055 0.798 −0.195 0.590
    Others’ discriminatory attitude −0.173 0.396 −0.089 0.674 −0.341 0.554
    Physical condition −0.116 0.490 −0.134 0.478 0.048 0.896
    Parents’ behaviour and attitude 0.445 0.025 0.611 0.008 0.442 0.464
    Psychological characteristics −0.219 0.249 −0.349 0.116 −0.038 0.924
    R2 0.221 0.421 0.568
    Weekend TPA
    Learning ability 0.175 0.377 0.258 0.295 −0.302 0.515
    Others’ discriminatory attitude 0.003 0.989 −0.022 0.927 0.383 0.602
    Physical condition −0.205 0.256 −0.286 0.188 −0.097 0.836
    Parents’ behaviour and attitude 0.099 0.629 0.287 0.235 −0.444 0.560
    Psychological characteristics −0.285 0.161 −0.507 0.048 0.247 0.630
    R2 0.117 0.256 0.296
    Out-of-school MPA
    Learning ability 0.266 0.168 0.150 0.550 0.047 0.853
    Others’ discriminatory attitude −0.207 0.324 −0.182 0.464 0.816 0.082
    Physical condition 0.094 0.587 0.149 0.498 −0.225 0.408
    Parents’ behaviour and attitude −0.150 0.449 0.085 0.728 −1.705 0.006
    Psychological characteristics −0.030 0.877 −0.188 0.456 0.558 0.088
    R2 0.178 0.213 0.777
    Out-of-school VPA
    Learning ability −0.005 0.979 −0.189 0.446 0.164 0.601
    Others’ discriminatory attitude −0.211 0.338 −0.139 0.569 0.493 0.338
    Physical condition 0.040 0.826 0.097 0.654 −0.244 0.455
    Parents’ behaviour and attitude 0.191 0.358 0.409 0.100 −1.325 0.035
    Psychological characteristics 0.041 0.841 0.008 0.974 0.251 0.477
    R2 0.096 0.239 0.674
    Out-of-school MVPA
    Learning ability 0.122 0.547 −0.060 0.816 0.112 0.675
    Others’ discriminatory attitude −0.236 0.292 −0.180 0.486 0.675 0.148
    Physical condition 0.070 0.701 0.136 0.552 −0.244 0.388
    Parents’ behaviour and attitude 0.054 0.796 0.321 0.215 −1.571 0.010
    Psychological characteristics 0.013 0.951 −0.082 0.755 0.415 0.194
    R2 0.066 0.150 0.760
      Note. Adjusted for age and BMI of participants; R2, R square; β, standardized regression coefficient; P-values less than 0.05, in bold.
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Barriers to Physical Activity among Children and Adolescents with Intellectual Disabilities: A Cross-sectional Study

doi: 10.3967/bes2023.154
    基金项目:  This study was supported by the Beijing Social Science Foundation [No. 16YTC038].
    作者简介:

    WANG Yu, male, born in 1991, MD, majoring in the physical activity of children

    JIN Qiu Meng, female, born in 1993, MD, majoring in the physical activity of children

    通讯作者: WANG Chao, PhD, Associate Professor, Tel: 86-10-82099206, E-mail: wangchao@cupes.edu.cn
注释:
1) Conflicts of Interest:

English Abstract

WANG Yu, JIN Qiu Meng, WANG Chao, HE Gang, LI Dong Sheng, MA Kai Yue. Barriers to Physical Activity among Children and Adolescents with Intellectual Disabilities: A Cross-sectional Study[J]. Biomedical and Environmental Sciences, 2023, 36(12): 1177-1182. doi: 10.3967/bes2023.154
Citation: WANG Yu, JIN Qiu Meng, WANG Chao, HE Gang, LI Dong Sheng, MA Kai Yue. Barriers to Physical Activity among Children and Adolescents with Intellectual Disabilities: A Cross-sectional Study[J]. Biomedical and Environmental Sciences, 2023, 36(12): 1177-1182. doi: 10.3967/bes2023.154
  • Regular physical activity (PA) has numerous advantages in improving the physical and mental health of children and adolescents[1]. However, the PA status quo for children and adolescents with intellectual disabilities (ID) is dismal. Children and adolescents with ID frequently exhibit sedentary behaviors because their physical, sensory, and/or cognitive impairments make it difficult to participate in sports and games with their peers[2]. They have higher rates of mental illness, obesity, type 2 diabetes, and other health problems than peers with typical development (TD).

    PA interventions can reduce the risk of chronic diseases in children and adolescents while improving their lifestyles. However, a recent systematic review and meta-analysis revealed that interventions designed for children and adolescents with TD are ineffective in improving the PA of children and adolescents with ID[3], possibly because they encounter more barriers to PA than children and adolescents with TD.

    To ensure the effectiveness of PA interventions, researchers must develop interventions based on a broad understanding of PA and its barriers. Many studies have investigated the factors that prevent children and adolescents with ID from participating in PA. However, recent reviews have revealed that the existing information is limited and uncertain[4], implying that more research into the factors influencing engagement in physical exercise is required[2]. In China, many children and adolescents have ID, but research on the barriers to PA in this population is scarce. Therefore, we aimed to explore the barriers to PA among Chinese children and adolescents with ID.

    This study employed a cross-sectional design. Sixty children and adolescents aged 8−18 years with mild to moderate ID were recruited from special education schools in Beijing and Qinhuangdao, China, and assessed following parental consent. The intelligence level of the participants was assessed by two researchers who had received training in psychological measurements to correctly perform the Combined Raven’s Test based on the PsyKey Psychometric System according to the prescribed procedures. The inclusion criteria were as follows: (1) mild to moderate ID rating, that is, IQ score between 55 and 89; (2) ability to understand the test content and follow simple instructions; and (3) no evident physical disabilities and ability to perform regular PA. This study was approved by the Ethics Committee of the Capital University of Physical Education and Sports (Ethical Approval No.: 2020A13). The study protocol was in accordance with the Declaration of Helsinki and informed consent was obtained from all participants and their parents.

    The variables included age, height, body weight, body mass index (BMI), IQ score, PA time, and barriers to PA. The ActiGraphGT3X+ accelerometer (ActiGraph, LLC, Pensacola, FL) was used to measure the participants’ PA. Actilife version 6.13.3 was used to download and analyze the data. Raw data were captured at a sampling interval of 1 s based on the PA intensity cut-off points developed by Zhu et al.[5]. Validated intensity cut-off points were 100–2,800 counts per minute (cpm) for light PA (LPA), 2,800–4,000 cpm for moderate PA (MPA), and ≥4,000 cpm for vigorous PA (VPA). Since barriers to PA may vary across different timeslots and places, PA data were reported as average daily, weekday, weekend, in-school, and out-of-school data after processing.

    Barriers to participants’ PA were reported by their parents, who completed the “Questionnaire on Barriers to Physical Activity of Children and Adolescents with Intellectual Disabilities.” This questionnaire uses a Likert 5-point scale to evaluate all questions, which are divided into five parts. With 2−4 questions in each part and 5 options in each question, i.e., “totally disagree−totally agree,” representing 1−5 points, respectively. The score for each part was the average score for all questions within this part. Questions in the five parts were all reverse assigned; the higher the score, the worse the performance in this part. The questionnaire was developed by our team based on previous studies. The specific formation process, reliability, and validity of the test results have been presented elsewhere.

    The Statistical Package for the Social Sciences Version 20.0 (IBM Corp., Armonk, NY, USA) was used for data analysis. Descriptive statistics were expressed in mean ± standard deviation (SD). Multivariate linear regression analysis was used to determine barriers to PA among children and adolescents with ID, with PA as dependent variables and the scores of the five questionnaire parts as independent variables controlling for age and BMI. The significance level was set at P < 0.05.

    The final valid sample consisted of 42 children and adolescents with mild to moderate ID (mean age: 11.45 ± 2.82 years, 66.67% boys) (Table 1).

    Table 1.  Participants’ characteristics (mean ± SD)

    VariablesTotal (n = 42)Boys (n = 28)Girls (n = 14)
    Age (year)11.45 ± 2.8211.64 ± 2.8811.07 ± 2.76
    Height (cm)145.87 ± 16.54149.23 ± 18.05a139.14 ± 10.64
    Weight (kg)46.49 ± 21.9650.87 ± 23.4837.73 ± 15.86
    BMI (kg/m2)20.89 ± 6.4521.85 ± 6.6818.97 ± 5.71
    IQ score (point)64.90 ± 13.7067.04 ± 14.3560.64 ± 11.61
    PA (min/day)
     Average daily
      LPA137.34 ± 41.20142.53 ± 45.54126.95 ± 29.52
      MPA26.83 ± 12.0528.07 ± 11.9224.36 ± 12.37
      VPA28.54 ± 13.2229.72 ± 14.7226.18 ± 9.58
      MVPA55.37 ± 21.9557.79 ± 22.8050.54 ± 20.04
      TPA192.71 ± 51.72200.32 ± 53.78177.49 ± 45.35
     Weekday
      LPA136.56 ± 40.22141.84 ± 44.59125.99 ± 28.15
      MPA27.58 ± 13.3229.02 ± 13.2424.69 ± 13.49
      VPA30.23 ± 14.9131.29 ± 15.8928.11 ± 13.01
      MVPA57.81 ± 24.9260.31 ± 25.0552.81 ± 24.80
      TPA194.36 ± 52.07202.14 ± 54.13178.79 ± 45.54
     Weekend
      LPA145.29 ± 57.71150.03 ± 62.16135.83 ± 48.32
      MPA27.15 ± 18.4627.97 ± 20.5725.51 ± 13.84
      VPA26.89 ± 15.6228.00 ± 17.5324.69 ± 11.08
      MVPA54.05 ± 30.6955.97 ± 34.2650.19 ± 22.56
      TPA199.34 ± 77.55206.00 ± 82.15186.02 ± 68.28
     In-school
      LPA46.15 ± 15.5946.17 ± 13.8546.10 ± 16.51
      MPA10.00 ± 5.4910.46 ± 5.629.11 ± 5.32
      VPA11.48 ± 5.6111.56 ± 5.5311.32 ± 5.99
      MVPA21.49 ± 10.1422.02 ± 10.1220.42 ± 10.46
      TPA67.64 ± 19.9768.19 ± 18.0966.52 ± 24.00
     Out-of-school
      LPA71.97 ± 24.33b76.70 ± 27.17a c62.50 ± 13.76d
      MPA13.81 ± 7.02b14.96 ± 7.44c11.53 ± 5.64
      VPA15.08 ± 9.73b16.14 ± 11.07c12.96 ± 6.06
      MVPA28.90 ± 14.83b31.10 ± 16.06c24.49 ± 11.24
      TPA100.86 ± 32.47b107.80 ± 34.70a c86.99 ± 22.68d
    PA barriers (point)
     Learning ability2.98 ± 1.133.17 ± 1.152.62 ± 1.05
     Others’ discriminatory attitude2.99 ± 1.393.17 ± 1.282.64 ± 1.57
     Physical condition2.29 ± 1.032.30 ± 0.912.27 ±1.26
     Parents’ behaviour and attitude2.83 ± 1.092.86 ± 1.042.79 ± 1.22
     Psychological characteristics2.39 ± 1.182.55 ± 1.182.07 ± 1.14
    Total score of barriers13.49 ± 4.0214.05 ± 3.7412.39 ± 4.45
      Note. LPA: light physical activity; MPA: moderate physical activity; VPA: vigorous physical activity; MVPA: moderate-to-vigorous physical activity; TPA: total physical activity; aP < 0.05, compared with girls; bP < 0.05, compared with in-school PA in all participants; cP < 0.05, compared with in-school PA in boys; dP < 0.05, compared with in-school PA in girls.

    Table 2 presents the regression analysis results of PA and their barriers. We only reported models with significant results. “Parents’ behaviour and attitude” was positively associated with overall participants’ weekend VPA, boys’ average daily VPA, and weekend VPA. However, it was negatively associated with girls’ weekday MPA, VPA, and MVPA (moderate-to-vigorous PA), and out-of-school MPA, VPA, and MVPA. This indicates that “parental behavior and attitude” may hinder girls’ PA, but not necessarily for boys. This could be related to the psychological differences between boys and girls, with boys being more energetic and risk-taking than girls, resulting in differing reactions to their parents’ attitudes. Previous research has found similar sex-based differences[6]. Parents play an important role as “gatekeepers” in the PA behavior of children and adolescents with TD[7]. This role of parents or other relatives is particularly important because individuals with ID face additional barriers to PA, and parental advocacy is critical to educating others about a child’s ability, providing support to others, finding additional activity opportunities, and ensuring the safety of child activities. Conversely, parents’ distrust of their child’s ability and overprotection may act as barriers to PA for the mentally disabled community due to the child’s identity as mentally disabled[8].

    Table 2.  Results of regression analysis of PA and their barriers for participants

    Variables Total Boys Girls
    β P β P β P
    Average daily VPA
    Learning ability −0.120 0.548 −0.223 0.358 −0.130 0.720
    Others’ discriminatory attitude −0.156 0.476 −0.110 0.644 0.525 0.378
    Physical condition −0.008 0.962 0.021 0.921 −0.233 0.537
    Parents’ behaviour and attitude 0.307 0.142 0.534 0.032 −0.983 0.135
    Psychological characteristics 0.008 0.969 −0.045 0.851 0.352 0.397
    R2 0.104 0.275 0.558
    Weekday MPA
    Learning ability −0.040 0.831 −0.112 0.649 −0.178 0.558
    Others’ discriminatory attitude −0.003 0.989 −0.094 0.698 1.163 0.044
    Physical condition 0.012 0.943 0.019 0.930 −0.316 0.326
    Parents’ behaviour and attitude −0.114 0.559 0.117 0.625 −1.611 0.014
    Psychological characteristics 0.056 0.770 −0.032 0.895 0.582 0.119
    R2 0.203 0.251 0.696
    Weekday VPA
    Learning ability −0.134 0.511 −0.285 0.256 −0.035 0.916
    Others’ discriminatory attitude −0.113 0.612 −0.111 0.651 0.831 0.152
    Physical condition 0.015 0.937 0.065 0.764 −0.314 0.374
    Parents’ behaviour and attitude 0.209 0.325 0.468 0.064 −1.346 0.042
    Psychological characteristics 0.036 0.860 0.052 0.834 0.304 0.423
    R2 0.062 0.232 0.627
    Weekday MVPA
    Learning ability −0.101 0.615 −0.240 0.356 −0.115 0.689
    Others’ discriminatory attitude −0.069 0.754 −0.120 0.638 1.069 0.050
    Physical condition 0.015 0.934 0.051 0.820 −0.337 0.279
    Parents’ behaviour and attitude 0.064 0.759 0.359 0.164 −1.582 0.013
    Psychological characteristics 0.052 0.802 0.016 0.951 0.476 0.171
    R2 0.080 0.170 0.721
    Weekend VPA
    Learning ability 0.060 0.745 0.055 0.798 −0.195 0.590
    Others’ discriminatory attitude −0.173 0.396 −0.089 0.674 −0.341 0.554
    Physical condition −0.116 0.490 −0.134 0.478 0.048 0.896
    Parents’ behaviour and attitude 0.445 0.025 0.611 0.008 0.442 0.464
    Psychological characteristics −0.219 0.249 −0.349 0.116 −0.038 0.924
    R2 0.221 0.421 0.568
    Weekend TPA
    Learning ability 0.175 0.377 0.258 0.295 −0.302 0.515
    Others’ discriminatory attitude 0.003 0.989 −0.022 0.927 0.383 0.602
    Physical condition −0.205 0.256 −0.286 0.188 −0.097 0.836
    Parents’ behaviour and attitude 0.099 0.629 0.287 0.235 −0.444 0.560
    Psychological characteristics −0.285 0.161 −0.507 0.048 0.247 0.630
    R2 0.117 0.256 0.296
    Out-of-school MPA
    Learning ability 0.266 0.168 0.150 0.550 0.047 0.853
    Others’ discriminatory attitude −0.207 0.324 −0.182 0.464 0.816 0.082
    Physical condition 0.094 0.587 0.149 0.498 −0.225 0.408
    Parents’ behaviour and attitude −0.150 0.449 0.085 0.728 −1.705 0.006
    Psychological characteristics −0.030 0.877 −0.188 0.456 0.558 0.088
    R2 0.178 0.213 0.777
    Out-of-school VPA
    Learning ability −0.005 0.979 −0.189 0.446 0.164 0.601
    Others’ discriminatory attitude −0.211 0.338 −0.139 0.569 0.493 0.338
    Physical condition 0.040 0.826 0.097 0.654 −0.244 0.455
    Parents’ behaviour and attitude 0.191 0.358 0.409 0.100 −1.325 0.035
    Psychological characteristics 0.041 0.841 0.008 0.974 0.251 0.477
    R2 0.096 0.239 0.674
    Out-of-school MVPA
    Learning ability 0.122 0.547 −0.060 0.816 0.112 0.675
    Others’ discriminatory attitude −0.236 0.292 −0.180 0.486 0.675 0.148
    Physical condition 0.070 0.701 0.136 0.552 −0.244 0.388
    Parents’ behaviour and attitude 0.054 0.796 0.321 0.215 −1.571 0.010
    Psychological characteristics 0.013 0.951 −0.082 0.755 0.415 0.194
    R2 0.066 0.150 0.760
      Note. Adjusted for age and BMI of participants; R2, R square; β, standardized regression coefficient; P-values less than 0.05, in bold.

    “Psychological characteristics” are negatively associated with boys’ weekend TPA. Generating a sense of pleasure in PA can increase the motivation to participate in more PA, and subjectively perceived benefits and barriers to PA can significantly impact participants’ participation in PA[9]. In addition, promoting activity and positive experiences from an early age facilitates future activity, whereas early negative experiences may be a barrier to PA in adolescents with ID[10].

    “Others’ discriminatory attitude” was positively associated with girls’ weekday MPA. This suggests that the discriminatory attitudes of others may encourage children and adolescents with ID to participate in PA. This anomalous result may be due to the specificity of the group of adolescents with ID, the insufficient effective sample size of the two schools, and PA, which may have resulted in random results in the data after a more detailed classification. Future studies could, therefore, attempt to increase the sample size and collect more comprehensive factors to improve the generalizability of the results.

    This is one of the few empirical studies to use a combination of direct and indirect measures to investigate barriers to PA in Chinese children and adolescents with ID. In conclusion, the barriers to PA reported in this study for boys with mild to moderate ID may be psychological characteristics, whereas for girls, they may be parental behavior and attitude. Given the limited sample and cross-sectional design of this study, research with larger sample and more robust design is needed to provide stronger evidence on barriers of PA in the young ID group.

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