Title: Promoting health and functioning in children with physical limitations through participation in physical activities: the ActiveCHILD study
Funder: Health Education England

Abstract: BACKGROUND The UK has an estimated 952,700 disabled children (0-18yrs), and physical limitations are among their most common difficulties. Children with physical limitations are at increased lifelong risk of secondary problems in health and functioning, including obesity, cognitive and social development, learning, and health-related quality of life. Published estimates of the costs of childhood-onset disabilities are limited, but indicate the costs are likely very high, around 30 billion per year or 0.6-1.5 million over the person's lifecourse. The impact of NHS services for children with physical limitations is hindered by lack of effective intervention techniques compatible with modern healthcare policies, and over-emphasis on bodily impairments as the sole pathway to improving children's health and functioning. Participation in physical activity behaviours is one of the most effective ways to promote all children's health and functioning, including bone, skeletal, cardiometabolic, adiposity, motor skill, cognitive, and psychosocial-emotional outcomes. Children with physical limitations are at especially high risk of inactivity. Increasing physical activity, e.g. crawling, floor play, and involvement in community groups (e.g. toddler groups), in children with physical limitations provides an opportunity to promote their health and functioning, and to prevent secondary health problems and disability. Enabling participation in physical activity in children with physical limitations is a stated priority of UK families and NHS professionals, but interventions remain unspecified and implementation in NHS practice is low. AIMS This research seeks to answer the question How should NHS professionals support children with physical limitations to participate in physical activity behaviours?. The purpose is to enable children's participation in physical activity behaviours in order to promote their health and functioning. The specific aims are: 1) To describe the levels and trajectories of physical activity participation in children with and without physical limitations. 2) To investigate relationships between children's physical activity participation, physical limitations, modifiable social environmental factors, health, and functioning. 3) To estimate the potential benefits and costs of early life participation in physical activity in children, including children with physical limitations from the perspective of the child, parents, the NHS, and society. 4) To design interventions to increase participation in physical activity behaviours in children with physical limitations. PLAN The research will combine three studies that reflect MRC guidance for developing and modelling complex interventions. Study 1 (years 1-5): A longitudinal study to generate evidence about participation in physical activity and its relationship with physical limitations, social environmental factors, health, and functioning in children with and without physical limitations. Study 2 (year 1): Econometric modelling to estimate the benefits and costs of participation in physical activity. Study 3 (years 2-5): Intervention development and modelling study to design specific, replicable interventions and model them with actual children and a cohort of 100,000 hypothetical children in terms of processes, benefits, and costs. The techniques will be advanced to formal piloting and evaluation through further parallel funding applications.POTENTIAL BENEFITS The research will help parents, professionals, healthcare commissioners, and policy-makers to be more knowledgeable about children's physical activity, its costs and benefits, and pathways to increasing it. This feeds into development of evidence-based training courses, guidelines, and policy for participation in physical activity. The specific, replicable physical activity interventions resulting from this research will be advanced to large-scale evaluation(s) through spin-off grant applications. The interventions, if effective, will directly improve participation, health, and functioning in children with physical limitations.

Lay abstract: Overall purpose: To enable participation in physical activity in children 0-5 years old with physical limitations, in order to promote their health and functioning. Aims: 1 and 2) To find out how much activity children with and without physical limitations do in day-to-day life, how children's activity changes over time, and why some children end up more active than others. 3) To estimate the potential impact (benefits and costs) that participation in physical activity may have for the child, parents, the NHS, and society. 4) To develop better ways for the NHS to support children with physical limitations to participate in physical activity (e.g. floor play, toddler groups, outdoor play). BACKGROUND What is the problem? Parents, policy makers, and government guidelines in England all say that NHS healthcare professionals (e.g. therapists and nurses) should help children with physical limitations to participate in physical activity. Healthcare professionals agree with this, but there is very little evidence to help them to know what to do. Why physical activity? Participation in physical activity is how children engage with the world and enjoy life, and is important for children's health. Participation in physical activity in children 0-5 years old improves the health of their bones, muscles, hearts, and blood vessels. It also improves children's mental health, physical skills, and thinking and learning. These benefits have been shown to carry over to later life. UK physical activity guidelines recommend that all children are active from birth. For example, under 5s who are walking should be active at least three hours a day. Only around 1 in every 10 children (0-5 years) in England meets the recommended level of physical activity. Disabled children are particularly inactive. There are around 952,700 disabled children (0-18 years) in the UK. They often experience physical limitations which, together with environmental barriers, restrict the children's participation in physical activity. Increasing participation in physical activity in children with physical limitations provides an opportunity: (i) To promote children's health and functioning both now and in the future. Functioning' is the World Health Organisation's term for all aspects of how people's bodies work, people's capacity to complete tasks, and people's involvement in life situations. (ii)To prevent further health problems (e.g. diabetes, osteoporosis, obesity, and depression) and disability for these children. (iii) To prevent some of the lifetime personal, family, health, and social care costs associated with childhood disability. DESIGN AND METHODS This research combines three related studies focused on children 0-5 years old, including children with physical limitations (e.g. difficulties in mobility or co-ordination). The children may also have other limitations, such as in communication and learning. The main outcomes will be the children's participation in physical activity, health, and functioning. Study 1: Investigation of physical activity in children with and without physical limitations, and factors that might affect their physical activity. Data will be collected over time using accelerometers (small devices that record movement) and questionnaires to parents. Study 2: Health economics study using existing information to estimate the impact (benefits and costs) of physical activity for children with and without physical limitations. Study 3: Partnership working with parents of children 0-5 years old with physical limitations, NHS professionals, and other community providers (e.g., toddler groups) to develop and pilot a range of interventions to enable participation in physical activity. How will parents and children be involved? Parents will steer the research, and jointly lead the involvement of people in the research and the sharing of the findings. They will also inform the data collection and analysis. OUTPUTS AND DISSEMINATION What are the end products? (1) Brief, practical, evidence-based summaries for families and professionals on Enabling children with physical limitations to participate in physical activities: what, how, and when? (2) Detailed intervention descriptions for professionals and commissioners, and funding applications for evaluating the interventions on a large scale. (3) Research publications on the evidence about physical activity and the interventions - and feeding this information to guide training, guidelines, commissioning, and policy. How will these be shared? Through existing networks of service users, healthcare professionals, and policy makers; social media; regional workshops; national and international conferences; and academic journals. What is the impact? Parents, healthcare professionals, NHS commissioners, and policy makers will have better information about how to promote health and functioning in children, including children with physical limitations. Specific interventions, and training for professionals, which will be advanced to large-scale evaluation. The interventions, if effective, will directly improve participation, health and functioning in children with physical limitations.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;METABOLIC AND ENDOCRINE;ORAL AND GASTROINTESTINAL;STROKE