The United Nations Convention on the Rights of Persons with Disabilities (CRPD) Article 31 states the need to collect data and report findings through disaggregating by disability ¹. Few countries have succeeded to achieve this in relation to physical activity among school-aged children ². It is not only important for countries to be able to do this for the purposes of providing the human rights for persons with disabilities, information that is reported in this way can help inform a range of stakeholders, including policy makers, educationalists, health promoters, town planners as well as individuals with disabilities.

To adhere to the Sustainable Development Goal (SDG) 4.7; learning to live together, appropriate data is needed to monitor these actions taken up at a national level ³. The gradual change for an inclusive environment in schools would be supportive to this particular SDG target. Early exposure to an inclusive environment can be useful to change perceptions surrounding disability stigma ⁴. Moreover, children with disabilities included inclusive physical activities experience improved perceptions of health and physical competences to carry out tasks ^5,6. As a relatively new area in educational sciences, the adoption of inclusive settings can take time to develop. For example, in Finland, there has been an increase from 8% in 2010 to 17% in 2017 of pupils who require intensified or special support in comprehensive schools ⁷. Many students with intensified support study in the comprehensive classroom, however most students with special support study in either special classrooms or special schools. Although these reports may seem promising for meeting the relevant SDG target, data is missing on the status of inclusion among children with disabilities, and in particular in relation to physical activity.

The physical activity environment can include formal physical education lessons, recess activities, active class breaks, as well as active transport to and from school. In addition to the physical health benefits from participating in physical activities, social and mental health benefits have been found ⁸.  The international recommendations for the minimum dose-response for children between the ages of 5-18 years old is, at least 60 minutes of moderate-to-vigorous intensity physical activity every day ⁹. There is some evidence that suggests that physical activity levels do not differ too much between young adolescents with and without disabilities ¹⁰, although other studies report significantly lower levels of PA among young adolescents with disabilities ¹¹. Moreover, young adolescents with disabilities report considerable amount of barriers to physical activity participation ¹².

It is important to know if differences exist between young adolescents with and without disabilities because such knowledge may help advance the field of adapted physical activity and health promotion. Tailor made programmes may be needed if differences in physical activity levels exist between groups. Therefore, it is a top research priority to investigate physical activity levels in the inclusive settings. Existing surveys used to collect national representative data on physical activity levels, such as the Finnish School-aged Physical Activity (F-SPA) and Health Behaviour in School-aged Children (HBSC) studies were initially designed prior to the increase of intensified or special support in comprehensive schools ^13,14. After Finland ratified the CRPD in 2016, there was a need for such surveys to be adapted so that young adolescents with disabilities could respond to comparable questions as in other national surveys.

An expert panel of researchers in health promotion and special education reduced the survey items from the HBSC (n=151) and F-SPA (n=207) study to 60 items. An iterative pilot design approach was used to refine the items further so the survey could be completed in a single class period. Visual images were integrated to increase item comprehension and adaptations to text through an easy-to-read language service. On completion of the main pilot study, young adolescents (n=74) completed a test-retest reliability study. The results from the intra-rater reliability study informed the formulation of the survey and three types of questionnaires were designed to meet the study objectives. A Large survey (L) was created without modifications, a Medium survey (M) had easy-to-read language modifications, and a Small survey (S) had fewer items. Teachers administered the surveys were given a guide to help select the correct type of survey based on the level of support needed for the pupil. For example, pupils with minimal support were given the L survey whereas, pupils with intensified support (mild challenges in attention deficit or in understanding and learning) were given the M survey. Pupils with special support (cognitive challenges and severe challenges in attention deficit) were given the S survey to complete. All surveys were completed anonymously, voluntarily with as little amount of support possible, thus encouraging pupils to complete with their own responses. Consent was given by the principal who had the authority from parents or guardians. Each survey had comparable items based on the Washington Group on Disability Statistics and UNICEF items on functional difficulties as well as the recommended cut-offs for disability 15. At the time of writing, this cut off is based on at least a lot of difficulties in at least one of the functions 16. In the L and M survey, physical activity was measured through a single item physical activity measure of at least 60 minutes per day of at least moderate-to-vigorous intensity. The physical activity item from the S survey was not used because comparable items have low validity for this population group. In the L, M, and S surveys, all participants completed items related to organised sport participation, body perceptions, and frequencies of bullying. The responses were pooled and outcome variables were analysed through multivariate regression analyses with the type of survey, sex and age as an independent variables. Level of significance for the study is 95%.

After combining the three surveys (n=878, boys=69% Mage=13.0y SD=2.5y), almost half (45%) completed the S survey, over a third (38%) completed the M survey, and fewer (17%) completed the L survey. Approximately 40% of young adolescents reported at least a lot of difficulties in their own self-care. Almost 10% reported difficulties in seeing, even when wearing glasses or contact lenses. The lowest prevalence of functional difficulty was learning difficulties (4.3%) and difficulties in walking at least 100m (4.4%). Approximately 22% of M- and L-students reported daily MVPA. PA levels averaged at four days among L- and M- students. However, significantly more L-students (88%) reported to take part in organised sport than M- (77%) and S-students (65%) respondents after controlling for age and sex (p<.001). Body image differed between respondents in L- (mean=1.5), M- (mean=1.6) and S-students (mean=0.8), but the pattern was not linear (p<.001). The odds ratio was 3.4 (CI=2.0:5.6) for the M-students who reported being bullied when compared to the L-survey respondents, whereas bullying among S-students were not statistically different from M-students. This is the first time in Finland whereby comparable surveys have been established for completion in the comprehensive schools, special classes and special schools. However, more comparative work is needed to verify the inclusive environment for teachers and organised sport participation. Adolescents who have mild challenges in attention or difficulties in understanding and learning reported high levels of bullying when compared to pupils with minimal support. However there is also high levels of participation of organized sports and greater levels of average body image. It may be necessary to target the organised sport sector to improve the socialising context versus the competitive nature of sports and consider how low-threshold activities could be supported in sport clubs, however more cross-associations need to be analysed before concluding discussions.

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