Towards Inclusive Physical Activity: A Systematic Review of Scopus Evidence on Multidimensional Barriers in Physical and Intellectual Disabilities
DOI:
https://doi.org/10.17309/tmfv.2025.4.28Keywords:
physical activity, disability and health equity, environmental accessibility, COM-B model, inclusive policy, sustainable development goals (SDGs)Abstract
Objectives. The study aimed to systematically analyze barriers to physical activity (PA) among individuals with physical and intellectual disabilities, integrating the COM-B model and Social Determinants of Health (SDH) framework to identify universal and disability-specific challenges.
Materials and methods. The present research involved a PRISMA-guided systematic review of 14 Scopus-indexed studies published between 2021 and 2025 from high- (HICs) and low-middle-income countries (LMICs). Thematic synthesis categorized barriers into environmental/structural, intrapersonal, and sociocultural domains.
Results. The results revealed environmental/structural barriers as predominant (10 studies), including transportation limitations (29% in Norway), inaccessible facilities (91% inactivity in Canadian children), and institutional resource gaps. Intrapersonal barriers (4 studies) included motivation deficits and gender stigma (8 unique barriers for women with physical disabilities). Distinct challenges were identified: individuals with physical disabilities faced fatigue (β = -0.34, p < 0.001) and chronic pain, while individuals with intellectual disabilities encountered caregiver dependency and cognitive limitations. Geographic disparities highlighted infrastructural barriers in HICs (e.g., Belgium’s adaptive program gaps) versus motivational/resource challenges in LMICs (e.g., 0% PA compliance among Turkish mothers).
Conclusions. The findings of this study underscore the need for tailored, multi-level interventions addressing disability-specific barriers and systemic inequities. Policy priorities include infrastructure investment, caregiver training, and stigma reduction to align with SDGs 3 (Health) and 10 (Reduced Inequalities). Cross-sector collaboration and context-driven strategies are critical to operationalize inclusive PA frameworks globally.
Downloads
References
WHO. (2011). World Report on Disability. World Report on Disability.
WHO. (2022). Global Status Report on Physical Activity 2022. WHO Press, World Health Organization. https://www.who.int/teams/health-promotion/physical-activity/global-status-report-on-physical-activity-2022
DHDS. (2020). Disability and Health Data System (DHDS) | Disability and Health Data System (DHDS) | CDC. https://www.cdc.gov/dhds/about/?CDC_AAref_Val=https://www.cdc.gov/ncbddd/disabilityandhealth/dhds/index.html
Naud, D., Généreux, M., Bruneau, J.-F., Alauzet, A., & Levasseur, M. (2019). Social participation in older women and men: differences in community activities and barriers according to region and population size in Canada. BMC Public Health. https://doi.org/10.1186/s12889-019-7462-1 DOI: https://doi.org/10.1186/s12889-019-7462-1
Southby, K., South, J., & Bagnall, A. M. (2019). A Rapid Review of Barriers to Volunteering for Potentially Disadvantaged Groups and Implications for Health Inequalities. Voluntas, 30(5), 907-920. https://doi.org/10.1007/S11266-019-00119-2 DOI: https://doi.org/10.1007/s11266-019-00119-2
UN. (2015). THE 17 GOALS | Sustainable Development. https://sdgs.un.org/goals
Bloemen, M., Van Wely, L., Mollema, J., Dallmeijer, A., & de Groot, J. (2017). Evidence for increasing physical activity in children with physical disabilities: a systematic review. Developmental Medicine and Child Neurology, 59(10), 1004–1010. https://doi.org/10.1111/dmcn.13422 DOI: https://doi.org/10.1111/dmcn.13422
Bloemen, M. A. T., Backx, F. J. G., Takken, T., Wittink, H., Benner, J., Mollema, J., & de Groot, J. F. (2015). Factors associated with physical activity in children and adolescents with a physical disability: A systematic review. Developmental Medicine and Child Neurology, 57(2), 137-148. https://doi.org/10.1111/dmcn.12624 DOI: https://doi.org/10.1111/dmcn.12624
Bondár, R. Z., di Fronso, S., Bortoli, L., Robazza, C., Metsios, G. S., & Bertollo, M. (2020). The effects of physical activity or sport-based interventions on psychological factors in adults with intellectual disabilities: a systematic review. Journal of Intellectual Disability Research, 64(2), 69-92). https://doi.org/10.1111/jir.12699 DOI: https://doi.org/10.1111/jir.12699
Dairo, Y. M., Collett, J., Dawes, H., & Oskrochi, G. R. (2016). Physical activity levels in adults with intellectual disabilities: A systematic review. Preventive Medicine Reports, 4, 209-219. Elsevier Inc. https://doi.org/10.1016/j.pmedr.2016.06.008 DOI: https://doi.org/10.1016/j.pmedr.2016.06.008
Sutherland, L., McGarty, A. M., Melville, C. A., & Hughes-McCormack, L. A. (2021). Correlates of physical activity in children and adolescents with intellectual disabilities: a systematic review. Journal of Intellectual Disability Research, 65(5), 405-436. https://doi.org/10.1111/jir.12811 DOI: https://doi.org/10.1111/jir.12811
Olasagasti-Ibargoien, J., Castañeda-Babarro, A., León-Guereño, P., & Uria-Olaizola, N. (2023). Barriers to Physical Activity for Women with Physical Disabilities: A Systematic Review. Journal of Functional Morphology and Kinesiology, 8(2). https://doi.org/10.3390/jfmk8020082 DOI: https://doi.org/10.3390/jfmk8020082
Tuncay, S., & Sarman, A. (2024). The relationship of spiritual orientation and caregiver burden of caregiver mothers with a child with cerebral palsy in Turkey. Child: Care, Health and Development, 50(1). https://doi.org/10.1111/cch.13141 DOI: https://doi.org/10.1111/cch.13141
Ashadi, K. et al. (2024). Comparison of barriers to physical activity to levels of physical activity and psychological well-being based on the demographic environment in the vision impairment disability group. Retos, 59. DOI: https://doi.org/10.47197/retos.v59.108122
McDermott, G., Brick, N. E., Shannon, S., Fitzpatrick, B., & Taggart, L. (2022). Barriers and facilitators of physical activity in adolescents with intellectual disabilities: An analysis informed by the COM-B model. Journal of Applied Research in Intellectual Disabilities, 35(3), 800-825. https://doi.org/10.1111/jar.12985 DOI: https://doi.org/10.1111/jar.12985
Devarajan, R., Prabhakaran, D., & Goenka, S. (2020). Built environment for physical activity—An urban barometer, surveillance, and monitoring. Obesity Reviews, 21(1), e12938. https://doi.org/10.1111/OBR.12938 DOI: https://doi.org/10.1111/obr.12938
Farrell, A., & Giles, A. K. (2022). Getting Kids Moving: Identifying Barriers for Inclusive Youth Physical Activity. The American Journal of Occupational Therapy, 76(Supplement_1), 7610510217p1-7610510217p1. https://doi.org/10.5014/ajot.2022.76s1-po217 DOI: https://doi.org/10.5014/ajot.2022.76S1-PO217
Shea, B., Bailie, J., Dykgraaf, S. H., Fortune, N., Lennox, N., & Bailie, R. (2022). Access to general practice for people with intellectual disability in Australia: a systematic scoping review. BMC Primary Care. https://doi.org/10.1186/s12875-022-01917-2 DOI: https://doi.org/10.1186/s12875-022-01917-2
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Guidelines and Guidance Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. Plos Medicine, 6(7). https://doi.org/10.1371/journal.pmed.1000097 DOI: https://doi.org/10.1371/journal.pmed.1000097
Lasda Bergman, E. M. (2012). Finding Citations to Social Work Literature: The Relative Benefits of Using Web of Science, Scopus, or Google Scholar. The Journal of Academic Librarianship, 38(6), 370-379. https://doi.org/10.1016/J.ACALIB.2012.08.002 DOI: https://doi.org/10.1016/j.acalib.2012.08.002
Mendes Rocha, Y., Acácio De Moura, G., Desidério, G. A., Henrique De Oliveira, C., Dantas Lourenço, F., Deadame, L., & Nicolete, F. (2023). The impact of fake news on social media and its influence on health during the COVID-19 pandemic: a systematic review. J Public Health, 31, 1007-1016. https://doi.org/10.1007/s10389-021-01658-z/Published DOI: https://doi.org/10.1007/s10389-021-01658-z
Liu, X., Han, H., Li, Z., Huang, S., Zhao, Y., Xiao, Q., & Sun, J. (2025). Barriers and facilitators to participation in physical activity for students with disabilities in an integrated school setting: a meta-synthesis of qualitative research evidence. Frontiers in Public Health, 13. https://doi.org/10.3389/fpubh.2025.1496631 DOI: https://doi.org/10.3389/fpubh.2025.1496631
Michalsen, H., Henriksen, A., Hartvigtsen, G., Olsen, M. I., Pedersen, E. R., Søndenaa, E., Jahnsen, R. B., & Anke, A. (2024). Barriers to physical activity participation for adults with intellectual disability: A cross-sectional study. Journal of Applied Research in Intellectual Disabilities, 37(4). https://doi.org/10.1111/jar.13242 DOI: https://doi.org/10.1111/jar.13242
Ma, Y., Liu, M., Liu, Y., Liu, D., & Hou, M. (2024). Exploring Physical Activity in Children and Adolescents with Disabilities: A Bibliometric Review of Current Status, Guidelines, Perceived Barriers, and Facilitators and Future Directions. Healthcare (Switzerland), 12(9). https://doi.org/10.3390/healthcare12090934 DOI: https://doi.org/10.3390/healthcare12090934
Wildekamp, M., Krops, L. A., Seves, B. L., Hettinga, F. J., Houdijk, H., Dekker, R., & Hoekstra, F. (2024). Physical activity barriers among adults with physical disabilities or chronic diseases during and after rehabilitation: the ReSpAct cohort study. European Journal of Adapted Physical Activity, 17, 11–11. https://doi.org/10.5507/euj.2024.008 DOI: https://doi.org/10.5507/euj.2024.008
Ascondo, J., Martín-López, A., Iturricastillo, A., Granados, C., Garate, I., Romaratezabala, E., Martínez-Aldama, I., Romero, S., & Yanci, J. (2023). Analysis of the Barriers and Motives for Practicing Physical Activity and Sport for People with a Disability: Differences According to Gender and Type of Disability. International Journal of Environmental Research and Public Health, 20(2). https://doi.org/10.3390/ijerph20021320 DOI: https://doi.org/10.3390/ijerph20021320
Boucher, T. Q., McIntyre, C. L., & Iarocci, G. (2023). Facilitators and Barriers to Physical Activity Involvement as Described by Autistic Youth with Mild Intellectual Disability. Advances in Neurodevelopmental Disorders, 7(4), 512-524. https://doi.org/10.1007/s41252-022-00310-5 DOI: https://doi.org/10.1007/s41252-022-00310-5
Yu, S., Wang, T., Zhong, T., Qian, Y., & Qi, J. (2022). Barriers and Facilitators of Physical Activity Participation among Children and Adolescents with Intellectual Disabilities: A Scoping Review. Healthcare (Switzerland), 10(2). https://doi.org/10.3390/healthcare10020233 DOI: https://doi.org/10.3390/healthcare10020233
Declerck, L., Stoquart, G., Lejeune, T., Vanderthommen, M., & Kaux, J. F. (2021). Barriers to development and expansion of adaptive physical activity and sports for individuals with a physical disability in sports clubs and centres. Science and Sports, 36(3), 202-209. https://doi.org/10.1016/j.scispo.2020.12.002 DOI: https://doi.org/10.1016/j.scispo.2020.12.002
MacEachern, S., Forkert, N. D., Lemay, J. F., & Dewey, D. (2022). Physical Activity Participation and Barriers for Children and Adolescents with Disabilities. International Journal of Disability, Development and Education, 69(1), 204–216. https://doi.org/10.1080/1034912X.2021.1952939 DOI: https://doi.org/10.1080/1034912X.2021.1952939
Mckenzie, G., Willis, C., & Shields, N. (2021). Barriers and facilitators of physical activity participation for young people and adults with childhood-onset physical disability: a mixed methods systematic review. Developmental Medicine and Child Neurology, 63(8), 914-924. https://doi.org/10.1111/dmcn.14830 DOI: https://doi.org/10.1111/dmcn.14830
Jacinto, M., Vitorino, A. S., Palmeira, D., Antunes, R., Ferreira, J. P., Bento, T., & Matos, R. (2021). Perceived barriers of physical activity participation in individuals with intellectual disability—A systematic review. Healthcare (Switzerland), 9(11). https://doi.org/10.3390/healthcare9111521 DOI: https://doi.org/10.3390/healthcare9111521
Barreno, M., Sisa, I., Cecilia, M., García, Y., Shen, H., Villar, M., Kovalskys, I., Fisberg, M., Gomez, G., Rigotti, A., Cortés, L. Y., Pareja, R. G., Herrera-Cuenca, M., & Guajardo, V. (2021). Association between built environment and physical activity in Latin American countries: a multicentre cross-sectional study. BMJ Open, 11, 46271. https://doi.org/10.1136/bmjopen-2020-046271 DOI: https://doi.org/10.1136/bmjopen-2020-046271
Groenewegen, P. P., Kroneman, M., & Spreeuwenberg, P. (2021). Physical accessibility of primary care facilities for people with disabilities: a cross-sectional survey in 31 countries. BMC Health Services Research. https://doi.org/10.1186/s12913-021-06120-0 DOI: https://doi.org/10.1186/s12913-021-06120-0
Smith, B., & Monforte, J. (2021). Title Disability, the Communication of Physical Activity and Sedentary Behaviour, and Ableism: A Call for Inclusive Messages Authors 5 Professor Brett Smith. British Journal of Sport Medicine, 55. DOI: https://doi.org/10.1136/bjsports-2020-103780
Geuze, L., Goossensen, A., & Schrevel, S. (2023). “Continuously struggling for balance”: The lived experiences of Dutch parents caring for children with profound intellectual and multiple disabilities. Journal of Intellectual & Developmental Disability, 48(2), 161-171. https://doi.org/10.3109/13668250.2022.2073707 DOI: https://doi.org/10.3109/13668250.2022.2073707
Özkan, R. S., & Numanoğlu-Akbaş, A. (2022). Physical activity and exercise benefits/barriers in mothers of children with motor disabilities. Irish Journal of Medical Science, 191(5), 2147-2154. https://doi.org/10.1007/s11845-021-02800-2 DOI: https://doi.org/10.1007/s11845-021-02800-2
Carmichael, J. H., Kalagher, K. M., Reznek, M. A., & Modi, P. (2023). Improving Accessibility in the Emergency Department for Patients with Disabilities: A Qualitative Study. Western Journal of Emergency Medicine, 24(3), 377–383. https://doi.org/10.5811/WESTJEM.58406 DOI: https://doi.org/10.5811/WESTJEM.58406
Sakalidis, K. E., Fadeeva, A., Hettinga, F. J., & Ling, F. C. M. (2023). The role of the social environment in inclusive sports participation-Identifying similarities and challenges in athletes with and without Intellectual Disabilities through coaches’ eyes: A qualitative inquiry. PLoS ONE, 18(1 January). https://doi.org/10.1371/journal.pone.0280379 DOI: https://doi.org/10.1371/journal.pone.0280379
Mayo, X., Liguori, G., Iglesias-Soler, E., Copeland, R. J., Clavel San Emeterio, I., Lowe, A., Del Villar, F., & Jimenez, A. (2019). The active living gender’s gap challenge: 2013-2017 Eurobarometers physical inactivity data show constant higher prevalence in women with no progress towards global reduction goals. BMC Public Health, 19(1). https://doi.org/10.1186/s12889-019-8039-8 DOI: https://doi.org/10.1186/s12889-019-8039-8
Kreinbucher‐Bekerle, C., Melville, C., Wells, J. S. G., & Ruf, W. (2022). The relationship between direct care providers’ physical activity behaviour and perceived physical activity needs for people with intellectual disabilities. Journal of Intellectual Disability Research, 66(12), 1023-1033. https://doi.org/10.1111/jir.12956 DOI: https://doi.org/10.1111/jir.12956
Johnson, L., Williams, G., Sherrington, C., Pilli, K., Chagpar, S., Auchettl, A., Beard, J., Gill, R., Vassallo, G., Rushworth, N., Tweedy, S., Simpson, G., Scheinberg, A., Clanchy, K., Tiedemann, A., & Hassett, L. (2023). The effect of physical activity on health outcomes in people with moderate-to-severe traumatic brain injury: a rapid systematic review with meta-analysis. BMC Public Health, 23(1), 63. https://doi.org/10.1186/s12889-022-14935-7 DOI: https://doi.org/10.1186/s12889-022-14935-7
Slavici, M. (2023). Mind the housing inclusion gap: The voice of people with disabilities in German housing politics. European Policy Analysis, 9(3), 271-289. https://doi.org/10.1002/epa2.1170 DOI: https://doi.org/10.1002/epa2.1170
Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6(1). https://doi.org/10.1186/1748-5908-6-42, DOI: https://doi.org/10.1186/1748-5908-6-42
WHO. (2024). Kesehatan dalam Kontribusi yang Ditetapkan secara Nasional. http://apps.who.int/bookorders.
Dan, J. (2020). Wearable sensors to improve activities in individuals with cerebral palsy. Developmental Medicine and Child Neurology, 62(6), 664. Blackwell Publishing Ltd. https://doi.org/10.1111/dmcn.14515 DOI: https://doi.org/10.1111/dmcn.14515
Knupper, K. (2018). Changing Parental Perceptions of Children with Disabilities Physical Capability in Physical Activity Throught a Family Fitness Program.
Adugna, M. B., Nabbouh, F., Shehata, S., & Ghahari, S. (2020). Barriers and facilitators to healthcare access for children with disabilities in low and middle income sub-Saharan African countries: a scoping review. BMC Health Services Research, 15. https://doi.org/10.1186/s12913-019-4822-6 DOI: https://doi.org/10.1186/s12913-019-4822-6
Magnusson, L., Kebbie, I., & Jerwanska, V. (2021). Access to health and rehabilitation services for persons with disabilities in Sierra Leone-focus group discussions with stakeholders. BMC Health Services Research, 22, 1003. https://doi.org/10.1186/s12913-022-08366-8 DOI: https://doi.org/10.1186/s12913-022-08366-8
Bailie, J., Fortune, N., Plunkett, K., Gordon, J., & Llewellyn, G. (2023). A call to action for more disability-inclusive health policy and systems research. BMJ Global Health, 8, 11561. https://doi.org/10.1136/bmjgh-2022-011561 DOI: https://doi.org/10.1136/bmjgh-2022-011561
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Kunjung Ashadi, Luh Putu Tuti Ariani, Khoirul Anwar Pulungan, Daniel Womsiwor, Nengah Sandi, Mohd Azrul Anuar Zolkafi
This work is licensed under a Creative Commons Attribution 4.0 International License.
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
