title: Systematic review of physical activity and exercise interventions to improve health, fitness and well-being of children and young people who use wheelchairs.
abstract: OBJECTIVE
  To perform a systematic review establishing the current evidence base for physical activity and exercise interventions that promote health, fitness and well-being, rather than specific functional improvements, for children who use wheelchairs.
  
  
  METHODS
  A systematic review using a mixed methods design.
  
  
  METHODS
  A wide range of databases, including Web of Science, PubMed, BMJ Best Practice, NHS EED, CINAHL, AMED, NICAN, PsychINFO, were searched for quantitative, qualitative and health economics evidence.
  participants: children/young people aged >25 years who use a wheelchair, or parents and therapists/carers. Intervention: home-based or community-based physical activity to improve health, fitness and well-being.
  
  
  RESULTS
  Thirty quantitative studies that measured indicators of health, fitness and well-being and one qualitative study were included. Studies were very heterogeneous preventing a meta-analysis, and the risk of bias was generally high. Most studies focused on children with cerebral palsy and used an outcome measure of walking or standing, indicating that they were generally designed for children with already good motor function and mobility. Improvements in health, fitness and well-being were found across the range of outcome types. There were no reports of negative changes. No economics evidence was found.
  
  
  CONCLUSIONS
  It was found that children who use wheelchairs can participate in physical activity interventions safely. The paucity of robust studies evaluating interventions to improve health and fitness is concerning. This hinders adequate policymaking and guidance for practitioners, and requires urgent attention. However, the evidence that does exist suggests that children who use wheelchairs are able to experience the positive benefits associated with appropriately designed exercise.
  
  
  BACKGROUND
  CRD42013003939.
authors.affiliation: Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: O'Brien
authors.affiliation: Health and Social Services Research and Child Health, School of Social Sciences , Bangor University , Bangor , UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Noyes
authors.affiliation: School of Healthcare Sciences , Bangor University , Bangor , UK.
authors.forename: Llinos Haf
authors.initials: LH
authors.lastname: Spencer
authors.affiliation: Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Kubis
authors.affiliation: Centre for Educational Development Appraisal and Research , University of Warwick , Coventry , UK.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Hastings
authors.affiliation: Whitaker Research Ltd , Bangor , UK.
authors.forename: Rhiannon
authors.initials: R
authors.lastname: Whitaker
keywords: Children; Disability; Exercise; Fit; Wheelchair