ORIGINAL ARTICLE
Perceptions of Barriers, Facilitators, and Outcomes of Aerobic Exercise in Community Fitness Facilities by Adults With Intellectual Disability
Iva Obrusnikova,
Ashley M. Steinbrecher,
Albert R. Cavalier,
Richard R. Suminski,
Cora J. Firkin,
Corresponding Author
Iva Obrusnikova
Department of Health Behavior and Nutrition Sciences, University of Delaware, Newark, Delaware, USA
Correspondence:
Iva Obrusnikova ([email protected])
Search for more papers by this authorAshley M. Steinbrecher
Department of Health Behavior and Nutrition Sciences, University of Delaware, Newark, Delaware, USA
Search for more papers by this authorAlbert R. Cavalier
School of Education, University of Delaware, Newark, Delaware, USA
Search for more papers by this authorRichard R. Suminski
Department of Health Behavior and Nutrition Sciences, University of Delaware, Newark, Delaware, USA
Search for more papers by this authorCora J. Firkin
Department of Health Behavior and Nutrition Sciences, University of Delaware, Newark, Delaware, USA
Search for more papers by this authorIva Obrusnikova,
Ashley M. Steinbrecher,
Albert R. Cavalier,
Richard R. Suminski,
Cora J. Firkin,
Corresponding Author
Iva Obrusnikova
Department of Health Behavior and Nutrition Sciences, University of Delaware, Newark, Delaware, USA
Correspondence:
Iva Obrusnikova ([email protected])
Search for more papers by this authorAshley M. Steinbrecher
Department of Health Behavior and Nutrition Sciences, University of Delaware, Newark, Delaware, USA
Search for more papers by this authorAlbert R. Cavalier
School of Education, University of Delaware, Newark, Delaware, USA
Search for more papers by this authorRichard R. Suminski
Department of Health Behavior and Nutrition Sciences, University of Delaware, Newark, Delaware, USA
Search for more papers by this authorCora J. Firkin
Department of Health Behavior and Nutrition Sciences, University of Delaware, Newark, Delaware, USA
Search for more papers by this authorFirst published: 29 July 2025
Funding: This work was supported by the Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the NIH (U54 GM104941).
ABSTRACT
Background
Adults with intellectual disability do not meet recommended physical activity (PA) levels, contributing to sedentary lifestyles and health disparities. Community fitness facilities (CFFs) present valuable opportunities for engagement but are often underutilised.
Method
This mixed-methods study, grounded in Social Cognitive Theory, combined semi-structured interviews and quantitative functional assessments to examine the perceived benefits, costs, barriers, and facilitators of aerobic exercise amongst 20 adults with intellectual disability, aged 19–43. Associations between perceptions, PA, and exercise performance were examined.
Results
Participants perceived substantial health benefits from aerobic exercise. However, physical discomfort and environmental constraints were commonly cited and were associated with lower PA levels and performance. Some perceived facilitators were unexpectedly correlated with increased sedentariness and lower functional performance, possibly due to programme design misalignments.
Conclusions
To enhance participation and health outcomes, CFF programmes must be tailored to address individual psychological needs and physical capabilities, whilst also improving accessibility and support.
Conflicts of Interest
The authors have declared no conflicts of interest.
Open Research
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
References
- American College of Sports Medicine. 2019. ACSM'S Health/Fitness Facility Standards and Guidelines. Human Kinetics.
- American College of Sports Medicine. 2021. ACSM'S Guidelines for Exercise Testing and Prescription. 11th ed. Wolters Kluwer.
- Backes, T., and C. Takacs. 2018. “A Comparison of Physiological Demand Between Self-Propelled and Motorized Treadmill Exercise.” International Journal of Physical Education, Fitness and Sports 7, no. 4: 13–21. https://doi.org/10.26524/ijpefs1842.
10.26524/ijpefs1842 Google Scholar
- Bandura, A. 1986. Social Foundations of Thought and Action. Prentice-Hall.
- Bandura, A. 2004. “Health Promotion by Social Cognitive Means.” Health Education & Behavior 31, no. 2: 143–164. https://doi.org/10.1177/1090198104263660.
- Bandura, A. 2006. “ Guide for Constructing Self-Efficacy Scales.” In Self-Efficacy Beliefs of Adolescents, edited by T. Urdan and F. Pajares, 307–337. IAP-Information Age Publishing, Inc.
- Bartlo, P., and P. J. Klein. 2011. “Physical Activity Benefits and Needs in Adults With Intellectual Disabilities: Systematic Review of the Literature.” American Journal on Intellectual and Developmental Disabilities 116, no. 3: 220–232. https://doi.org/10.1352/1944-7558-116.3.220.
- Bohannon, R. W., P. A. Larkin, A. C. Cook, J. Gear, and J. Singer. 1984. “Decrease in Timed Balance Test Scores With Aging.” Physical Therapy 64, no. 7: 1067–1070. https://doi.org/10.1093/ptj/64.7.1067.
- Bondár, R. Z., S. di Fronso, L. Bortoli, C. Robazza, G. S. Metsios, and M. Bertollo. 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, no. 2: 69–92. https://doi.org/10.1111/jir.12699.
- Bouvet, C., and A. Coulet. 2016. “Relaxation Therapy and Anxiety, Self-Esteem, and Emotional Regulation Among Adults With Intellectual Disabilities: A Randomized Controlled Trial.” Journal of Intellectual Disabilities 20, no. 3: 228–240. https://doi.org/10.1177/1744629515605942.
- Bouzas, S., R. I. Martínez-Lemos, and C. Ayán. 2019. “Effects of Exercise on the Physical Fitness Level of Adults With Intellectual Disability: A Systematic Review.” Disability and Rehabilitation 41, no. 26: 3118–3140. https://doi.org/10.1080/09638288.2018.1491646.
- Brooker, K., A. Mutch, L. McPherson, R. Ware, N. Lennox, and K. van Dooren. 2015. “We Can Talk While We're Walking: Seeking the Views of Adults With Intellectual Disability to Inform a Walking and Social-Support Program.” Adapted Physical Activity Quarterly 32, no. 1: 34–48. https://doi.org/10.1123/apaq.2013-0067.
- Bull, F. C., S. S. Al-Ansari, S. Biddle, et al. 2020. “World Health Organization 2020 Guidelines on Physical Activity and Sedentary Behaviour.” British Journal of Sports Medicine 54, no. 24: 1451–1462. https://doi.org/10.1136/bjsports-2020-102955.
- Calder, A., G. Sole, and H. Mulligan. 2018. “The Accessibility of Fitness Centers for People With Disabilities: A Systematic Review.” Disability and Health Journal 11, no. 4: 525–536. https://doi.org/10.1016/j.dhjo.2018.04.002.
- Casey, A. F., X. Wang, and K. Osterling. 2012. “Test-Retest Reliability of the 6-Minute Walk Test in Individuals With Down Syndrome.” Archives of Physical Medicine and Rehabilitation 93, no. 11: 2068–2074. https://doi.org/10.1016/j.apmr.2012.04.022.
- Caspersen, C. J., K. E. Powell, and G. M. Christenson. 1985. “Physical Activity, Exercise, and Physical Fitness: Definitions and Distinctions for Health-Related Research.” Public Health Reports 100, no. 2: 126–131.
- Centers for Disease Control and Prevention. 2019. Behavioral Risk Factor Surveillance System Questionnaire (BRFSS). U.S. Department of Health and Human Services.
- Chen, C. C., S. Lim, and G. A. Clardy. 2024. “Qualitative Exploration of the Physical Activity Engagement Among College Students With Intellectual Disabilities.” International Journal of Developmental Disabilities 70: 1367–1376. https://doi.org/10.1080/20473869.2023.2177582.
- Corbin, J., and A. Strauss. 2008. Basics of Qualitative Research. 3rd ed. Sage Publications.
- Craig, C. L., A. L. Marshall, M. Sjorstrom, et al. 2003. “International Physical Activity Questionnaire: 12-Country Reliability and Validity.” Medicine and Science in Sports and Exercise 35, no. 8: 1381–1395. https://doi.org/10.1249/01.MSS.0000078924.61453.FB.
- Creswell, J. W., V. L. P. Clark, M. L. Gutmann, and W. E. Hanson. 2003. “ Advanced Mixed Methods Research Designs.” In Handbook of Mixed Methods in Social & Behavioral Research, edited by A. Tashakkori and C. Teddlie, 161–196. Sage.
- Dairo, Y. M., J. Collett, H. Dawes, and G. R. Oskrochi. 2016. “Physical Activity Levels in Adults With Intellectual Disabilities: A Systematic Review.” Preventive Medicine Reports 4: 209–219. https://doi.org/10.1016/j.pmedr.2016.06.008.
- Diaz, K. M. 2020. “Leisure-Time Physical Activity and All-Cause Mortality Among Adults With Intellectual Disability: The National Health Interview Survey.” Journal of Intellectual Disability Research 64, no. 2: 180–184. https://doi.org/10.1111/jir.12695.
- Enright, P. L., and D. L. Sherrill. 1998. “Reference Equations for the Six-Minute Walk in Healthy Adults.” American Journal of Respiratory and Critical Care Medicine 158, no. 5: 1384–1387. https://doi.org/10.1164/ajrccm.158.5.9710086.
- Fereday, J., and E. Muir-Cochrane. 2006. “Demonstrating Rigor Using Thematic Analysis: A Hybrid Approach of Inductive and Deductive Coding and Theme Development.” International Journal of Qualitative Methods 5, no. 1: 80–92. https://doi.org/10.1177/160940690600500107.
10.1177/160940690600500107 Google Scholar
- Frey, G. C., A. M. Buchanan, and D. D. R. Sandt. 2005. “I'd Rather Watch TV: An Examination of Physical Activity in Adults With Mental Retardation.” Mental Retardation 43, no. 4: 241–254. https://doi.org/10.1352/0047-6765(2005)43[241:IRWTAE]2.0.CO;2.
- García-Domínguez, L., P. Navas, M. Á. Verdugo, and V. B. Arias. 2020. “Chronic Health Conditions in Aging Individuals With Intellectual Disabilities.” International Journal of Environmental Research and Public Health 17, no. 9: 3126.
- Guerra-Balic, M., G. R. Oviedo, C. Javierre, et al. 2015. “Reliability and Validity of the 6-Min Walk Test in Adults and Seniors With Intellectual Disabilities.” Research in Developmental Disabilities 47: 144–153. https://doi.org/10.1016/j.ridd.2015.09.011.
- Hawkins, A., and R. Look. 2006. “Levels of Engagement and Barriers to Physical Activity in a Population of Adults With Learning Disabilities.” British Journal of Learning Disabilities 34, no. 4: 220–226. https://doi.org/10.1111/j.1468-3156.2005.00381.x.
10.1111/j.1468-3156.2005.00381.x Google Scholar
- Heller, T., K. Hsieh, and J. H. Rimmer. 2004. “Attitudinal and Psychosocial Outcomes of a Fitness and Health Education Program on Adults With Down Syndrome.” American Journal of Mental Retardation 109, no. 2: 175–185. https://doi.org/10.1352/0895-8017(2004)109<175:AAPOOA>2.0.CO;2.
- Hennink, M. M., B. N. Kaiser, and V. C. Marconi. 2017. “Code Saturation Versus Meaning Saturation: How Many Interviews Are Enough?” Qualitative Health Research 27, no. 4: 591–608. https://doi.org/10.1177/10497323166653.
- Howie, E. K., T. L. Barnes, S. McDermott, J. R. Mann, J. Clarkson, and R. A. Meriwether. 2012. “Availability of Physical Activity Resources in the Environment for Adults With Intellectual Disabilities.” Disability and Health Journal 5: 41–48. https://doi.org/10.1016/j.dhjo.2011.09.004.
- Hsieh, H.-F., and S. E. Shannon. 2005. “Three Approaches to Qualitative Content Analysis.” Qualitative Health Research 15, no. 9: 1277–1288. https://doi.org/10.1177/1049732305276687.
- Hsieh, K., J. H. Rimmer, and T. Heller. 2014. “Obesity and Associated Factors in Adults With Intellectual Disability.” Journal of Intellectual Disability Research 58, no. 9: 851–863. https://doi.org/10.2519/jospt.1997.25.6.395.
- Hsu, P.-J., H.-S. Chou, Y.-H. Pan, Y. Ju, C.-L. Tsai, and C.-Y. Pan. 2021. “Sedentary Time, Physical Activity Levels and Physical Fitness in Adults With Intellectual Disabilities.” International Journal of Environmental Research and Public Health 18, no. 9: 5033. https://doi.org/10.3390/ijerph18095033.
- Hutzler, Y., and O. Korsensky. 2010. “Motivational Correlates of Physical Activity in Persons With an Intellectual Disability: A Systematic Literature Review.” Journal of Intellectual Disability Research 54, no. 9: 767–786. https://doi.org/10.1111/j.1365-2788.2010.01313.x.
- IBM Corportation. 2023. “IBM SPSS Statistics for Mac (Version 29.0.1) [Computer Software].” https://www.ibm.com/products/spss-statistics.
- Landes, S. D., J. D. Stevens, and M. A. Turk. 2021. “Cause of Death in Adults With Intellectual Disability in the United States.” Journal of Intellectual Disability Research 65, no. 1: 47–59. https://doi.org/10.1111/jir.12790.
- Lante, K. A., J. W. Walkley, M. Gamble, and M. V. Vassos. 2011. “An Initial Evaluation of a Long-Term, Sustainable, Integrated Community-Based Physical Activity Program for Adults With Intellectual Disability.” Journal of Intellectual & Developmental Disability 36, no. 3: 197–206. https://doi.org/10.3109/13668250.2011.593163.
- Lee, P. H., D. J. Macfarlane, T. H. Lam, and S. M. Stewart. 2011. “Validity of the International Physical Activity Questionnaire Short Form (IPAQ-SF): A Systematic Review.” International Journal of Behavioral Nutrition and Physical Activity 8: 115. https://doi.org/10.1186/1479-5868-8-115.
- Locke, E. A., and G. P. Latham. 2013. “ Goal Setting Theory: The Current State.” In New Developments in Goal Setting and Task Performance, 623–630. Routledge.
10.4324/9780203082744 Google Scholar
- Lynn, M. R. 1986. “Determination and Quantification of Content Validity.” Nursing Research 35, no. 6: 382–385. https://doi.org/10.1097/00006199-198611000-00017.
- Malterud, K., V. D. Siersma, and A. D. Guassora. 2016. “Sample Size in Qualitative Interview Studies: Guided by Information Power.” Qualitative Health Research 26, no. 13: 1753–1760. https://doi.org/10.61838/kman.intjssh.7.3.2.
- Masuki, S., M. Morikawa, and H. Nose. 2019. “High-Intensity Walking Time Is a Key Determinant to Increase Physical Fitness and Improve Health Outcomes After Internal Walking Training in Middle-Aged and Older People.” Mayo Clinic Proceedings 94, no. 12: 2415–2426. https://doi.org/10.1016/j.mayocp.2019.04.039.
- McAuley, E., and B. Blissmer. 2000. “Self-Efficacy Determinants and Consequences of Physical Activity.” Exercise and Sport Sciences Reviews 28, no. 2: 85–88.
- Messent, P. R., C. B. Cooke, and J. Long. 1998. “Physical Activity, Exercise and Health of Adults With Mild and Moderate Learning Disabilities.” British Journal of Learning Disabilities 26, no. 1: 17–22. https://doi.org/10.1111/j.1468-3156.1998.tb00041.x.
10.1111/j.1468-3156.1998.tb00041.x Google Scholar
- Miles, M. B., M. A. Huberman, and J. Saldana. 2019. Qualitative Data Analysis: A Methods Sourcebook. 4th ed. SAGE Publications.
- Mitchell, F., K. Stalker, L. Matthews, et al. 2018. “A Qualitative Exploration of Participants' Experiences of Taking Part in a Walking Programme: Perceived Benefits, Barriers, Choices and Use of Intervention Resources.” Journal of Applied Research in Intellectual Disabilities 31, no. S1: 110–121. https://doi.org/10.1111/jar.12326.
- Morin, D., J. Mérineau-Côté, H. Ouellette-Kuntz, M. J. Tassé, and M. Kerr. 2012. “A Comparison of the Prevalence of Chronic Disease Among People With and Without Intellectual Disability.” American Journal on Intellectual and Developmental Disabilities 117, no. 6: 455–463. https://doi.org/10.1352/1944-7558-117.6.455.
- Newton, R. 1989. “Review of Tests of Standing Balance Abilities.” Brain Injury 3, no. 4: 335–343. https://doi.org/10.3109/02699058909004558.
- Obrusnikova, I., A. R. Cavalier, H. M. Novak, and A. E. Blair. 2020. “The Effect of Systematic Prompting on the Acquisition of Two Muscle-Strengthening Exercises by Adults With Moderate Disabilities.” Journal of Behavioral Education 29, no. 3: 584–605. https://doi.org/10.1007/s10864-019-09328-7.
- Obrusnikova, I., A. R. Cavalier, H. M. Novak, A. E. Blair, and R. R. Suminski. 2021. “The Effects of a Community-Based Familiarization Intervention on Independent Performance of Exercise Tasks by Adults With Intellectual Disabilities.” Journal of Intellectual & Developmental Disability 59, no. 3: 239–255. https://doi.org/10.1352/1934-9556-59.3.239.
10.1352/1934-9556-59.3.239 Google Scholar
- Obrusnikova, I., A. R. Cavalier, R. R. Suminski, A. E. Blair, C. J. Firkin, and A. M. Steinbrecher. 2021. “A Resistance Training Intervention for Adults With Intellectual Disability in the Community: A Pilot Randomized Clinical Trial.” Adapted Physical Activity Quarterly 38, no. 4: 546–568. https://doi.org/10.1123/apaq.2020-0218.
- Obrusnikova, I., C. J. Firkin, and W. B. Farquhar. 2022. “A Systematic Review and Meta-Analysis of the Effects of Aerobic Exercise Interventions on Cardiorespiratory Fitness in Adults With Intellectual Disability.” Disability and Health Journal 15, no. 1: 101185. https://doi.org/10.1016/j.dhjo.2021.101185.
- Obrusnikova, I., H. M. Novak, and A. R. Cavalier. 2019. “The Effect of Systematic Prompting on the Acquisition of Five Muscle-Strengthening Exercises by Adults With Mild Intellectual Disabilities.” Adapted Physical Activity Quarterly 36: 447–471. https://doi.org/10.1123/apaq.2018-0192.
- Olusanya, B. O., S. M. Wright, M. K. C. Nair, et al. 2020. “Global Burden of Childhood Epilepsy, Intellectual Disability, and Sensory Impairments.” Pediatrics 146, no. 1: e20192623. https://doi.org/10.1542/peds.2019-2623.
- Oppewal, A., T. I. M. Hilgenkamp, R. van Wijck, J. D. Schoufour, and H. M. Evenhuis. 2015. “Physical Fitness Is Predictive for a Decline in the Ability to Perform Instrumental Activities of Daily Living in Older Adults With Intellectual Disabilities: Results of the HA-ID Study.” Research in Developmental Disabilities 41-42: 76–85. https://doi.org/10.1016/j.ridd.2015.05.002.
- Reiner, M., C. Niermann, D. Jekauc, and A. Woll. 2013. “Long-Term Health Benefits of Physical Activity—A Systematic Review of Longitudinal Studies.” BMC Public Health 13: 813–822. https://doi.org/10.1186/1471-2458-13-813.
- Rimmer, J. H., S. Padalabalanarayanan, L. A. Malone, and T. Mehta. 2017. “Fitness Facilities Still Lack Accessibility for People With Disabilities.” Disability and Health Journal 10, no. 2: 214–221. https://doi.org/10.1016/j.dhjo.2016.12.011.
- Schalock, R. L., R. Luckasson, and M. J. Tassé. 2021. “An Overview of Intellectual Disability: Definition, Diagnosis, Classification, and Systems of Supports.” American Journal on Intellectual and Developmental Disabilities 126: 439–442.
- Sharma, S. K., S. K. Mudgal, R. Gaur, J. Chaturvedi, S. Rulaniya, and P. Sharma. 2024. “Navigating Sample Size Estimation for Qualitative Research.” Journal of Medical Evidence 5, no. 2: 133–139. https://doi.org/10.4103/jme.Jme_59_24.
10.4103/jme.Jme_59_24 Google Scholar
- Shogren, K. A., K. M. Burke, M. H. Anderson, et al. 2018. “Evaluating the Differential Impact of Interventions to Promote Self-Determination and Goal Attainment for Transition-Age Youth With Intellectual Disability.” Research and Practice for Persons With Severe Disabilities 43, no. 3: 165–180. https://doi.org/10.1177/1540796918779775.
- Sparrow, S., D. Cicchetti, and C. Saulnier. 2016. Vineland Adaptive Behavior Scales–Third Edition (Vineland-3). American Guidance Service.
- Spooner, F., and D. Spooner. 1984. “A Reivew of Chaining Techniques: Implications for Future Reserach and Practice.” Education and Training in Mental Retardation 19: 114–124.
- Stancliffe, R. J., and L. L. Anderson. 2017. “Factors Associated With Meeting Physical Activity Guidelines by Adults With Intellectual and Developmental Disabilities.” Research in Developmental Disabilities 2017, no. 62: 1–14. https://doi.org/10.1016/j.ridd.2017.01.009.
10.1016/j.ridd.2017.01.009 Google Scholar
- Taliaferro, A. R., and L. Hammond. 2016. ““I Don't Have Time”: Barriers and Facilitators to Physical Activity for Adults With Intellectual Disabilities.” Adapted Physical Activity Quarterly 33, no. 2: 113–133. https://doi.org/10.1123/APAQ.2015-0050.
- Temple, V. A. 2007. “Barriers, Enjoyment, and Preference for Physical Activity Among Adults With Intellectual Disability.” International Journal of Rehabilitation Research 30, no. 4: 281–287. https://doi.org/10.1097/MRR.0b013e3282f144fb.
- Temple, V. A., and J. W. Walkley. 2007. “Perspectives of Constraining and Enabling Factors for Health-Promoting Physical Activity by Adults With Intellectual Disability.” Journal of Intellectual & Developmental Disability 32, no. 1: 28–38. https://doi.org/10.1080/13668250701194034.
- The United States Census Bureau. 2020. National Survey of Children's Health.
- Tudor-Locke, C., E. J. Aguiar, H. Han, et al. 2019. “Walking Cadence (Steps/Min) and Intensity in 21–40 Year Olds: CADENCE-Adults.” International Journal of Behavioral Nutrition and Physical Activity 16: 1–11. https://doi.org/10.1186/s12966-019-0769-6.
- Turgeon, S., A. MacKenzie, C. S. Batcho, and J. D'Amour. 2024. “Making Physical Activity Fun and Accessible to Adults With Intellectual Disabilities: A Pilot Study of a Gamification Intervention.” Journal of Applied Research in Intellectual Disabilities 37, no. 3: e13213. https://doi.org/10.1111/jar.13213.
- Tyrer, F., A. J. Dunkley, J. Singh, et al. 2019. “Multimorbidity and Lifestyle Factors Among Adults With Intellectual Disabilities: A Cross-Sectional Analysis of a UK Cohort.” Journal of Intellectual Disability Research 63, no. 3: 255–265. https://doi.org/10.1111/jir.12571.
- van Schijndel-Speet, M., H. M. Evenhuis, R. van Wijck, P. van Empelen, and M. A. Echteld. 2014. “Facilitators and Barriers to Physical Activity as Perceived by Older Adults With Intellectual Disability.” Intellectual and Developmental Disabilities 52, no. 3: 175–186. https://doi.org/10.1352/1934-9556-52.3.175.
- Warburton, D. E. R., V. Jamnik, S. S. D. Bredin, R. J. Shephard, and N. Gledhill. 2018. “The 2019 Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) and Electronic Physical Activity Readiness Medical Examination (ePARmed-X+).” Health & Fitness Journal of Canada 11, no. 4: 80–83. https://doi.org/10.14288/hfjc.v11i4.270.
10.14288/hfjc.v11i4.270 Google Scholar
- Wehmeyer, M. L., and K. A. Shogren. 2017. “ Goal Setting and Attainment and Self-Regulation.” In Handbook of Positive Psychology in Intellectual and Developmental Disabilities: Translating Research Into Practice, edited by K. A. Shogren, M. L. Wehmeyer, and N. N. Singh, 231–245. Springer.
10.1007/978-3-319-59066-0_16 Google Scholar
- Wilson, A., V. Longo, J. Ma, and S. Bulut. 2024. “Perceived Barriers and Facilitators to Physical Activity Among Individuals With Disabilities: A Qualitative Study.” International Journal of Sport Studies for Health 7, no. 3: 10–17. https://doi.org/10.61838/kman.intjssh.7.3.2.
10.61838/kman.intjssh.7.3.2 Google Scholar
- World Health Organization. 2019. Global Action Plan on Physical Activity 2018–2030: More Active People for a Healthier World. World Health Organization.
- World Health Organization. 2020. WHO Guidelines on Physical Activity and Sedentary Behaviour. World Health Organization.
- Zablotsky, B., A. E. Ng, L. I. Black, and S. J. Blumberg. 2023. “Diagnosed Developmental Disabilities in Children Aged 3–17 Years: United States, 2019–2021.” https://stacks.cdc.gov/view/cdc/129520.
