Inadequate physical activity (PA) levels and sedentary behaviors are linked to non-communicable diseases and all-cause mortality in the global population (1–4). Compared to the average population, people with different disabilities show even lower PA levels and increased risk of comorbidities (5). The benefits of being physically active reinforce the need for providing opportunity access to perform PA to everyone of all ages (6–8). Although people with disabilities face several barriers that limit their participation in PA and which differ from those without disabilities, challenging the possibilities to ensure participation and the benefits of regular practice in this group is imperative (9–11). Global efforts to promote PA in people living with disabilities resulted in the first World Health Organization (WHO) guidelines based on wide-ranging evidence and describing recommendations that could facilitate the practice and participation of overall society activities in this specific population (12).

Most population data to estimate or monitor PA patterns are conducted through national surveys, where the available data are mainly focused on high-income countries or northern regions (North America and Europe) (13). Thereby, a lack of evidence is appreciable in low-to-middle-income countries or Latin-American and African regions. For example, in Netherlands and Australia, adults living with disabilities had lower PA levels and were less likely to meet PA guidelines than those without disabilities (13, 14). These findings align with another study conducted in the United States, where half of the adults were physically inactive and more likely to have a chronic disease (15–17). According to Martin Ginis et al. (5), the significant disparities in participation rates and the near-absence of population-level data on PA in people with disabilities from low-income and middle-income countries represent a problem for healthcare systems and population quality of life. In this regard, more extraordinary global efforts towards international goals such as the United Nations (UN) Sustainable Development Goals (SDG) of healthy lives and well-being for all have been directed to face these challenges. In this sense, the Latin American region is an active member state responsible for covering and accomplishing the SDG (18). One study analyzed the participation in PA of people with chronic health physical conditions (e.g., chronic back pain, angina, arthritis, asthma, diabetes, hearing problems, tuberculosis, visual impairment, and edentulism) in a few South American countries (i.e., Brazil, Ecuador, Paraguay, and Uruguay) (19). Even though this study provides novel information about a multi-national scope, people with disabilities and different impairments (i.e., hearing, intellectual, or mixed-related disabilities) were not incorporated into the analysis.

The 2020 Chilean National Physical Activity and Sports Habits in Populations with Disabilities study (CNPASHPwD; Estudio Nacional de Hábitos de Actividad Física y Deporte en Población con Discapacidad in Spanish) (20), aims to collect information and epidemiological evidence through the application of a national survey about patterns of practice during coronavirus disease 19 (COVID-19) pandemic. However, to favor fewer infection rates during the pandemic, international organizations and governments imposed various preventive measures, such as restricted movement of the citizens, social/physical distancing, and banning social gatherings (21). It is essential to highlight that people with disabilities are especially exposed to the effects of the pandemic, where confinement strategies drastically decreased PA levels and increased sedentary lifestyles even more, which directly affected their health parameters (22, 23). Exploring the prevalence of PA levels considering participants with the mentioned health conditions and socio-demographic data from a country in the South American region may provide novel knowledge and bridge gaps in local factors that could facilitate intervention strategies targeting the population with a disability.

Therefore, this study aimed (i) to describe the prevalence of reported PA levels of Chilean adults with disabilities and (ii) to examine the associations of their PA levels with socio-demographic factors and type of disability participating in the 2020 CNPASHPwD during the COVID-19 pandemic.

In total, 3,150 participants were considered for this analysis. The participants’ socio-demographic characteristics and PA levels are described in Table 1. Of the participants, 59.8% were female, 52.9% reported visual impairments or disability, 50.8% belonged to the two lowest socio-economic quintiles, 44.3% resided in the central region, and 82.9% lived in urban settings. Regarding PA levels, only 11.9% of the participants were physically active.

Table 2 illustrates the prevalence of PA according to the socio-demographic characteristics of the participants with disabilities. Those who reported meeting PA recommendations were younger than their counterparts (p < 0.001). According to gender, larger proportions of males were classified as active compared to female participants (p < 0.001). There was a particular higher prevalence of non-practice of PA among those participants with physical (23.6%), intellectual (4.1%), and mixed (16.2%) disabilities (p < 0.001). Physical inactivity prevalence increased in participants from the poorest quintiles (i.e., E: 20.8%), while most active participants were categorized in the wealthiest group (i.e., A: 12.5%). A lower prevalence of participants from the northern region achieved ≥150 min/week (27.1%) in comparison to participants from the central area (47.3%). Nearly 80% of participants from urban areas fulfilled the PA recommendations.

The ORs and the 95% CI reported PA levels according to the socio-demographic characteristics of the participants can be found in Figure 1. Participants with visual and hearing impairment (OR = 1.30–2.16; 95% CI: 1.233; 2.957) were associated with higher odds of achieving international recommendations of PA than those with physical impairment. Also, older participants had fewer odds of being categorized as physically active (i.e., ≥ 150 min/week) compared to younger participants (OR = 0.98; 95% CI: 0.978; 0.987). In addition, female participants were less likely to be physically active than male participants (OR = 0.83; 95% CI: 0.709; 0.965). Moreover, participants who belong to the lowest quintiles were less likely to meet current PA recommendations (OR = 0.53–0.66; 95% CI: 0.371;0.901). Finally, participants living in the central or southern regions of the country were more likely to participate in adequate levels of PA than those living in the northern area (OR = 1.68–2.17; 95% CI: 1.355; 2.598).

To the best of our knowledge, this is the first study to describe the prevalence of PA patterns and socio-demographic characteristics in a sample of Latin American adults with disabilities during the COVID-19 pandemic. The current study showed that 11.9% met the PA guidelines, and 62.6% declared non-physical activity. Moreover, males, younger, with visual or hearing disabilities from the wealthiest economic status and with residency in the central and southern zones of the country, were more likely to meet adequate levels of PA recommendations.

According to PA levels, these results align with previous studies, showing that people with disabilities reported lower levels than those without disabilities (14, 30). Furthermore, this can be seen in a recent work performed on South American adults during the COVID-19 pandemic lockdown showed that 56.9% of the participants were categorized as physically active, a higher prevalence compared to the reported in the present study (31). In addition, McGuire et al. (32) described that adults with disabilities were less likely to engage with recommended levels of PA in comparison to their counterparts, showing the health disparities which could be involved in this population and higher odds of developing chronic diseases (17, 33). Furthermore, previous reports showed that people with disabilities could also achieve health benefits by performing PA at levels even below international recommendations (5, 34), considering the particularities of the specific disability (35, 36). In this line, PA has been demonstrated as a feasible tool for improving and maintaining health in these groups, wherein every minute counts (29); however, compliance with PA recommendations is still low, corresponding to the reported by the participants. The update of the WHO guidelines on PA and sedentary behavior includes recommendations for adults living with a disability, facilitating the development and implementation of policies for participation in this population. However, considering the extensive range of health and functional profiles, a broader level of PA recommendation is needed according to each group’s characteristics as the evidence available increases (12). Additional challenges could be faced by people with disabilities during measures of social isolation, whereas previous studies reported that the use of assistive devices and environmental barriers limit PA participation (9, 11, 37), and the impact of the housing-built environment on the quality of life (38).

Some authors suggested that along with the natural aging process, adults with a disability could experience more difficulties associated with an accelerated musculoskeletal impairment-specific process, secondary health conditions, and lower levels of PA that affect overall health and quality of life (39–42). In this context, PA is critical to maintaining or improving physical functioning in people with chronic health conditions (43). According to age, the results indicated that lower PA levels were presented in major proportions among older adults. Previous studies have shown that older adults without disabilities are more likely to be inactive and present an increased cardiovascular risk than younger adults (44, 45). Moreover, higher amounts of sedentary behavior time could negatively impact the increased risk of premature mortality, especially in physically inactive individuals, reinforcing the importance of maintaining higher levels of total PA at any intensity (46, 47). The public health crisis increased the risk of death and severe outcomes due to COVID-19 in older people living with disabilities more than in people without disabilities, significantly impacting the disability community and probably affecting their levels of PA (48).

In terms of gender, female participants presented a higher prevalence of physical inactivity, in line with previous studies among women with disabilities (49–52). Women with disabilities are at higher risk of inactivity-related health consequences due to facing significant barriers in different spheres and difficulting participating in PA (5, 53). Especially in Latin America, data from people without disabilities described that women’s participation in PA had been identified as insufficient and lower than in other regions of the world. This concern reinforces the need to develop specific strategies for this population (53, 54).

Previous reports informed that people with multiple disabilities present the lowest PA levels probably due to the number of barriers at different levels (i.e., psychological, environmental factors, activity costs, and lack of support) and difficulties that are determinants of participation (49, 55). In addition, Lobenius-Palmér et al. (50) assessed the prevalence of PA in youths with multiple disabilities and reported that participants with hearing impairments were the most physically active. This finding is consistent with the results found in this study, where participants with hearing and visual impairments present higher levels of PA than those from the physical disability group. Probably, these results could be influenced due to the specific-local barriers that face people with physical and intellectual disabilities, limiting their possibilities to engage in different types of PA and achieve optimal health (15, 39, 40). Additionally, the disability itself, the requirement of support personnel, and the use of assistive-specific devices to facilitate the practice of PA could limit the chances of opportunities for participation (9). People with disabilities face complex challenges where government responses do not fully address the population’s basic needs in a health emergency scenario such as the COVID-19 pandemic, hindering even more, the possibility of being concerned about the practice of PA (23). The pandemic measures drastically impact the PA levels and the increment of sedentary behaviors in people living with disabilities (56) and able-bodied populations (57), a cautionary aspect that should be considered when interpreting the results.

People with disabilities experience higher living costs due to difficulties with functional autonomy, support requirements, and access to specific equipment, facing more significant inequalities than people without disabilities, summating in a considerable socio-economic disadvantage (58–60). It is remarkable to describe that the disability prevalence, on average, is higher in low-and lower-middle-income countries than in upper-middle-and high-income countries (59). Particularly, socio-economic status was identified as a relevant factor that influences the time engaging in PA and impacts the prevalence of sitting time, showing inequality patterns between the poorest and wealthy segments of the Chilean population (61). This study showed a higher prevalence of physical inactivity in the lowest quintiles. Similarly, previous research highlighted that the principal determinants in low socio-economic status communities to engage in PA participation involve the urban environment, financial constraints, work-life integration, community engagement, social support, and individual psychological factors (62). People living with disabilities are constantly constrained by barriers that difficult their involvement in PA and sports, where the economic factor could be relevant for accessing to sport, requiring specific equipment, or higher transport costs, among others (10, 11, 37, 63–65). Werneck et al. (65) described that socio-economic inequalities in South American populations without disabilities increased for total and leisure-time physical activity over the years. According to the author’s knowledge, there are no reports considering PA disparities according to the socio-economic characteristics of people living with disabilities in the Latin American region prior or during the COVID-19 pandemic.

The COVID-19 pandemic disproportionately affected the socio-economic lives, particularly the poorest and most vulnerable segments of society, such as women, the older adults, and people living with disabilities (48). The lack of adequate socio-economic support for the population with disabilities during the pandemic could have significant repercussions on daily life, considering the low levels of participation in the labor market and high levels of involvement in the informal economic employment in the region, constrained by health measures limiting all type of activities (66, 67). Our results demonstrated greater physical activity levels in people living in the central and southern regions of the country when compared to those from the northern regions. These results are probably conditioned by the country’s geographical diversity, where the Chilean population is exposed to high levels of urbanization, principally in the central zone (68). In particular, Sadarangani et al. (69) showed that in the Chilean non-impaired population, the same differences in PA level were presented according to the region of residence, reinforcing the particularities of each environment and the possible impact on health parameters. Moreover, local disability-specific policies and consistent actions promoting physical activity in people with disabilities are important to address greater participation levels advocating this aspect as a basic human right. Although Chile is a member of the UN, and there are some policies and actions oriented specifically to this population segment, the results of this study suggest relevant disparities due to the high prevalence of physical inactivity, remarking that these strategies are not enough (70). Furthermore, people with disabilities could experience more barriers and fewer opportunities to access services or infrastructure. Consequently, they participate less in PA in rural contexts, facing more challenges than their counterparts in urban residency zones (71). Lastly, cultural-specific characteristics could also constraint the participation of people with disabilities, considering that some local barriers may be relevant only in the study country and not in other regions, impacting in a unique form the complex relationship between barriers and facilitators for engagement in physical activity (72, 73).

The data analyzed in this study is subject to the following licenses/restrictions: Transparency law. Requests to access these datasets should be directed to https://www.portaltransparencia.cl/PortalPdT/.

The studies involving human participants were reviewed and approved by Sports Ministry. The patients/participants provided their written informed consent to participate in this study.

KS and MH involved in conceptualization and roles or writing—original draft. KS involved in data curation, performed the formal analysis and has full access to all the data in the study and is responsible for the decision to submit for publication. KS, MH, RR-C, CC-M, RR, CA, GF, and NA-F were involved in writing—review and editing. All authors contributed to the article and approved the submitted version.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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