Abstract
Physical activity (PA) provides positive health outcomes for children and youth with disabilities (CYD). However, CYD often face systemic barriers that limit their involvement in PA. This realist review applied the context-mechanism-outcome (CMO) framework to explore characteristics of effective PA interventions for CYD. Initial CMO program theories were developed in consultation with our Family Engagement Research Team. Peer-reviewed literature was searched across six databases to refine the program theories. Eligible studies: 1) targeted CYD, 2) described PA participation interventions, and 3) reported increases in PA. A team of reviewers independently screened titles, abstracts, and full texts using Covidence. Data extraction involved using Microsoft Copilot to generate preliminary extractions based on structured prompts, which were verified by a second extractor. Extracted data were used to test and refine CMO program theories. The final sample consisted of 45 studies. Most studies included participants with autism spectrum disorder (37.8%), intellectual disability (26.7%), and cerebral palsy (22.2%) and were conducted in school (40.0%), home (33.3%), and community (31.1%) settings. Interventions were mainly focused on physical training (84.4%), compared to behavioural (33.3%) or participation-focused (17.8%) approaches. All studies included at least two of the six experiential elements of quality participation; engagement was the most frequently reported (84.4%), while meaning was the least common (57.8%). The quality participation building blocks likely play a critical role in enhancing PA participation for CYD, and their absence could limit intervention effectiveness. This realist review contributes valuable insights into the contexts and mechanisms that optimally support PA participation for CYD.
