Understanding Pediatrician Perspectives on Physical Activity for Children with Special Health Care Needs

To assess pediatric clinician knowledge of physical activity recommendations, their approach to physical activity counseling, and their interest in a structured academic fitness program for children and youth with special health care needs (CYSHCN). Electronic questionnaire was developed by cardiovascular, psychology, and exercise physiology collaborators at an academic children's hospital. Regional pediatric clinicians across an urban and rural catchment area were anonymously surveyed. Subgroup differences were assessed using Student's t test, Fisher's exact test, and logistic regression. Survey response rate was 22% (78/351), including 60 general and 18 subspecialty clinicians, half of which (49%) are in rural practice. Over 80% reported general knowledge of physical and psychological benefits of physical activity, although only 49% were aware of specific physical activity recommendations for CYSHCN. Most (90%) perceive that CYSHCN participate in physical activity less than age-matched peers but only 55% routinely discuss physical activity recommendations. Clinicians who report exercising ≥ 4 days per week are more likely to discuss physical activity with their patients (OR 2.74, 95% CI 1.06-7.13; p = 0.038). Nearly, all (95%) clinicians supported development of a dedicated academic cardiometabolic exercise program for CYSHCN. Clinicians identified time commitment (89%), transportation (84%), insurance (79%), and differing interest levels of patients/families (43%) as potential participation barriers. While most clinicians are aware that physical activity benefits CYSHCN, clinical knowledge gaps exist regarding appropriate recommendations and counseling. Physical activity practices of healthcare professionals may be associated with frequency of patient counseling. Development of structured physical activity programs for CYSHCN should seek to improve knowledge and counseling, include clinicians as physical activity role models, and limit participation barriers.