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Disabil Rehabil. 2013 Sep;35(19):1630-5. doi: 10.3109/09638288.2012.748844. Epub 2013 Jan 22.

Stages of change in physical activity behavior in children and adolescents with cerebral palsy.

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Rudolf Magnus Institute of Neuroscience and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Rembrandtkade 10, Utrecht, The Netherlands.



To identify facilitators and barriers frequently experienced by families of children with cerebral palsy (CP) and associated with being at the pre-intention, intention and action stages for physical activity.


Qualitative study involving in-depth focus group interviews with 33 ambulatory children and adolescents with CP and their parents (nā€‰=ā€‰33). These interviews were followed by questionnaires to determine stage of behavior change (i.e. pre-intention, intention and action) related to the child's participation in physical activity.


Families who were classified in the intention stage of behavioral change were more likely to identify environmental barriers related to the social environment and the facility or program than parents at the pre-intention stage. Families who were classified into intention and action stages were more likely to identify facilitators related to parental factors than families at the pre-intention stage. Moreover, at the action stage facilitators were related to the facility/program.


The identified facilitators and barriers, organized according to three stages of change (pre-intention, intention and action), provide important theoretical insights into how and why children and adolescents with CP and their parents might change their physical activity behavior.


Understanding the barriers and facilitators of physical activity for children and adolescents with CP is essential for designing effective interventions to promote participation in this group. Using the three stages of change and the identified barriers and facilitators for participation can result in tailored advice to increase physical activity behavior.

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