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Objectives To enhance the confidence of children and adolescents with medical conditions and disabilities to engage in healthy, active lifestyles. Children with medical conditions and disabilities often exhibit more sedentary lifestyles relative to peers and are at increased risk of poor health outcomes. Clinical experience suggests physical activity confidence is an important factor influencing physical activity participation. Methods This randomized controlled trial evaluates an evidence-based intervention targeting physical activity confidence among children and adolescents with medical conditions and disabilities. Potential participants, 8 to 18 years of age diagnosed with a medical condition or disability, will be screened for adequate physical activity motivation but a lack confidence. Consenting participants (n=128) will be randomized 1:1 to a 12-week in-person or virtual physical activity intervention (24 hours/week total) led by a Registered Kinesiologist or control (assessments only). The intervention will combine physical activity participation with education about physical activity knowledge, goal setting, motivation and self-management. Primary outcomes are self-reported physical activity confidence and motivation at baseline, post-intervention and three months following intervention completion. A secondary outcome will be daily physical activity minutes assessed by accelerometry. A repeated measures mixed model will be used to compare outcomes between the in-person intervention, virtual intervention, and control groups (alpha=0.05). Conclusions This trial aims to assess the impact of a novel application of behaviour change theory on physical activity confidence among children and adolescents living with medical conditions or disabilities. Increased physical activity confidence, knowledge and skills could enable these youth to lead a more active lifestyle.

OBJECTIVES This exploratory mixed-methods study explored the barriers to physical activity, daily physical activity and submaximal exercise capacity among children with and at risk for cardiomyopathy and children with atrial septal defects. METHODS The study followed a convergent parallel mixed methodology design. Semi-structured interviews explored physical activity barriers. Seven-day accelerometry assessed moderate-to-vigorous physical activity, and an intermittent cardiopulmonary exercise test measured submaximal exercise capacity. RESULTS Twenty children, including 5 with cardiomyopathy (n=2 females, 14.2 ± 2.7 years old), 7 who were genotype-positive phenotype-negative for cardiomyopathy (n=5 females, 10.6 ± 3.3 years old) and 8 with atrial septal defects (n=4 females, 9.4 ± 3.8 years old) were recruited. Children with cardiomyopathy reported disease-specific physical activity barriers, while children who were genotype-positive phenotype-negative perceived barriers related to lack of time, parent support or activity motivation. The average daily moderate-to-vigorous physical activity was less than the recommended 60-minutes/day (n=20, mean 48.1 ± 18.0 minutes). Children with cardiomyopathy participated a median of 141.2 [interquartile range (IQR): 98.8) minutes of light-intensity physical activity and a median of 55.6 (IQR: 34.6) minutes of moderate-to-vigorous physical activity. The average submaximal exercise capacity was low (n=16, 25.2 ± 5.7 mL/kg/min). Estimated submaximal exercise capacity, including metabolic equivalent (4.5 ± 3.1 METs), respiratory exchange ratio (median = 1.0, IQR: 0.09) and ratings of perceived exertion (median = 7, IQR: 5) at peak exercise suggest that children with cardiomyopathy appear to have the exercise capacity to participate in low-to-moderate intensity activities. CONCLUSIONS These novel data suggest that a diagnosis of cardiomyopathy may not preclude children from participating in a healthy, active lifestyle. However, they perceive disease-specific physical activity barriers and may require support to optimize their level of participation for optimal health.

OBJECTIVES Children with congenital heart disease (CHD) often lack confidence and demonstrate limited movement skills during physical activity. Community-based sport programs have been suggested to build their confidence and competence. This study examined the feasibility and physical literacy impact of an existing community-based sport program for children with moderate to complex CHD. METHODS This pilot study employed a parallel mixed method, single-case experimental design to evaluate the feasibility and impact of a weekly, community-based sport intervention (Sportball©). Intervention field notes and focus group transcripts were analysed deductively to inform feasibility. Physical literacy outcomes were measured using the Canadian Assessment of Physical Literacy. Paired t-tests examined changes in physical literacy scores, while qualitative data informed perceived changes in physical literacy tasks. RESULTS Participants (n=11, 45% female) were 8.2 ± 1.2 years. Nine children completed >80% of the 1-hour Sportball© sessions (10 lessons total). No adverse events occurred during or as a result of the intervention. Enabling participants to recognize the sensations of exercise and whether or not they needed to rest, designing activities and instructions to mitigate the risk of body contact, and accommodating the needs of participants with developmental/attentional limitations were important factors embedded into the design of the program, contributing to its feasibility. Participants reported perceived improvements in movement skill and torso endurance/strength, changes which were reflected in the objective physical literacy measures (movement skill: ∆ mean= 2.0 ± 0.98 points, p=0.07, r=0.57; torso endurance/strength: ∆ mean= 5.27 ± 7.20 seconds, p=0.44, r=0.26). CONCLUSIONS The Sportball© intervention was feasible for children with CHD, including those with activity restrictions or developmental delays. Children enjoyed the program and wanted it to continue. Measurable improvements in movement skill and muscular endurance were recognized by participants. Future trials evaluating Sportball©’s impact with larger samples and multiple 10-week sessions are recommended.