The Association Between Physical Activity Levels and Self-Esteem Among Children With and Without Disabilities: A Cross-Sectional Study

Abstract

Introduction

Physical activity is important to support health and well-being. Studies have shown an association between self-esteem and physical activity. However, there is a lack of studies assessing these relationships among children with disabilities. This study aimed to determine the relationship between physical activity and self-esteem among children with and without physical and sensory disabilities.

Methods

This cross-sectional study included convenience samples of typically developing children and children with physical or sensory disabilities. Data collection was conducted using an online survey.

Results

Children with disabilities had significantly lower levels of self-esteem than children without disabilities (p=0.001), while their overall physical activity score was lower but not statistically significant. After adjustment for the included factors, each unit increase in physical activity score was significantly associated with an increase in self-esteem score by 1.82 (95%CI: 0.78 to 2.85, p=0.001).

Conclusion

Higher physical activity levels were associated with increased self-esteem. Promoting and facilitating physical activity is essential for improving children’s well-being and self-esteem.

Keywords

physical activity self-esteem child cross-sectional studies disabilities parents

1. Introduction

Physical activity (PA) can improve the physical and psychological well-being of children. Physical activity promotes healthy growth and development in children and adolescents.¹The World Health Organization (WHO) defined physical activity as the movement of the body using skeletal muscles leading to energy expenditure, and the WHO recommends that children and adolescents spend at least 60 minutes a day of moderate-to-vigorous PA intensity.¹ A recent systematic review revealed that physical activity improves various aspects of mental well-being, including anxiety, depression, stress, and self-esteem.² PA significantly improves the quality of life of individuals with disabilities through improving physical self-esteem.³

Various reviews have shown that the levels of physical activity are notably lower among children with disabilities than among their typically developing peers.⁴ Disability is a multidimensional concept that includes sensory or physical impairments of body function, or limitations in activity and participation in daily activities.⁵ Children with disabilities often encounter physical, social, and psychological barriers that may reduce their ability to participate in physical activity.⁶

Studies have shown that self-esteem is an essential factor for overall children’s development and satisfaction.⁷ Self-esteem is defined as an individual’s positive perception of their worth and ability.⁸ Low self-esteem may lead to depression and suicidal thoughts.⁹ Numerous studies have established a positive association between PA and self-esteem among children.^3,10,11 A systematic review by Biddle et al. (2019) found that both structured and unstructured PA are associated with higher self-esteem in children and adolescents.¹¹ These findings highlight PA as an important contributor to psychosocial development during childhood period.

Disability is a dynamic construct that emerges from the interaction between an individual’s health condition and the surrounding social, cultural, and environmental contexts.¹² Physical activity is shaped by a range of socio-ecological factors, including personal characteristics, family and school environments, and broader organizational and community settings.^12,13 Furthermore, children’s participation in daily physical activity may be influenced by family structure and cohesion within Arabic culture. Family encouragement, acceptance, engagement of children’s friends in PA, and social support in Arabic communities provide children, particularly those with disabilities, with greater opportunities to engage in PA.^6,14,15 However, there are some challenges that may limit the participations of children with disabilities in PA, including limited facilities, lack of programs, and transportation concerns.¹⁴

Growing evidence indicates that this positive association extends to children and adolescents with disabilities, who often face barriers that may affect their participation in PA. Recent research has further supported the association between PA and self-esteem among individuals with disabilities. For instance, a study by Alhumaid and Said (2023) revealed that weekly PA levels of physical activity were the strongest predictor of self-esteem among individuals with physical disabilities,¹⁰ reinforcing the importance of PA in this population.

Despite this expanding body of research, the existing literature remains focused on typically developing children and adolescents, with few studies focusing on children with physical and sensory disabilities. There is a lack of research examining the relationship between PA and self-esteem and comparing them between children with and without physical and sensory disabilities. It is important to examine these relationships to determine whether the well-documented benefits of physical activity on self-esteem are also present among children with disabilities, as they are in typically developing children. Addressing this gap is particularly important to ensure equity and provide evidence-based recommendations for promoting physical activity and psychological well-being among all children. Therefore, the present study aimed to compare the levels of physical activity and self-esteem between typically developing children and children with disabilities and examine the relationship between physical activity and self-esteem within each group.

2. Methods

2.1 Study Design, Settings, and Procedure

This was a quantitative cross-sectional study. The study was conducted through an online survey that included parents of typically developing children and children with physical disabilities from different regions of Saudi Arabia. The online survey was distributed via social media platforms, including WhatsApp. Moreover, the recruitment process involved direct communication with centers for children with physical and sensory disabilities to distribute invitations for the study to the parents. Written informed consent was obtained from both parents and children before their participation in the study. The children were allowed to fill out the questionnaire with parental assistance if they could read and comprehend it. The data were secured and anonymized to ensure the confidentiality of the participants. Data were collected from June 2025 to October 2025. The study adhered to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for cross-sectional observational research.¹⁶

2.2 Participants

This study used a convenience sample. Parents and their children with and without physical or sensory disabilities, aged between 8 and 18 years, and enrolled in the school system, were invited to participate in the study and recruited. The types of disabilities included in this study were 1) physical disabilities, such as paralysis or impairment of body structure, and 2) sensory disabilities, such as blindness or hearing loss.

Self-reported questionnaires can be completed independently by children and their parents. Completing the questionnaire required sufficient comprehension and cognitive abilities. Children were excluded if they had severe intellectual or learning disabilities that could compromise the validity of their self-reported data.

G*Power was used to calculate the recommended sample size.¹⁷ The input values for the difference between two independent means were as follows: an alpha of 0.05, a power of 0.90, and a medium effect size of 0.5. The recommended sample size was 140. Ultimately, the study included a total of 202 participants.

2.3 Research Instrument

Data were collected using self-administered questionnaires sent to parents and their children to invite them to participate in this study. The questionnaire included demographic questions. The Physical Activity Questionnaire for Older Children (PAQ-C) was used to assess the level of physical activity.¹⁸ The PAQ-C is a self-administered questionnaire that includes nine items designed for a 7-day recall. It aimed to measure general moderate-to-vigorous physical activity levels among school-aged children.¹⁸ It is a five-point Likert scale ranging from (1) low physical activity to (5) high physical activity; the final PAQ-C composite score is the result of the mean of the nine items. Question 10 was removed because it was designed for students with an unusual health status. Several studies have used the PAQ-C scale to assess physical activity among children with disabilities in similar social contexts and Arabic-speaking populations and have reported good reliability and validity.^15,19 In this study, the PAQ-C demonstrated excellent internal consistency, with a Cronbach’s alpha (α) value of 0.94.

The Rosenberg Self-Esteem Scale (RSES) was used to assess global self-esteem using a 10-item Likert-type scale.⁸ The scale scoring was on a 4-point scale ranging from 1 (strongly agree) to 4 (strongly disagree). The total score for the RSES ranged from a minimum of 10 to a maximum of 40, with higher scores indicating higher self-esteem. Five items were reverse coded. The Arabic version of the scale has been used to assess self-esteem in Arabic-speaking populations with disabilities. The RSES showed, in a previous study, well-established validity and good reliability of 0.83.¹⁰ In the current study, the scale demonstrated low internal consistency, with a Cronbach’s alpha (α) value of approximately 0.60; this low reliability may be due to children’s limited understanding of the negatively worded items.

2.4 Data Analysis

Statistical analyses were performed using SPSS version 28 (IBM Corp., Armonk, NY, USA). Mean and standard deviation (SD) were used to describe the numerical data. For categorical data, frequencies and percentages were used and analyzed between the two groups using an independent sample t-test. The Pearson’s correlation coefficient was calculated to estimate the degree of correlation between the two quantitative variables. Linear regression analysis was performed to assess the factors associated with the RSES score. Statistical significance was defined as a two-tailed P-value of <0.05.

3. Results

A total of 202 children were included in this study, of whom 139 (68.8%) were typically developed children (with no disability) and 63 (31.2%) had disabilities. In terms of age, 39.6% of typically developed children and 28.6% of children with disabilities were in the age range (8 – 10 years), and 22.3% vs. 38.1% were in the age range (11 – 13 years). The majority of parents were married (92.8% of the typically developed children and 74.6% of the children with disabilities). As for economic status, participants with 5001 – 18000 SAR/month constituted the largest group, including 50.4% of the typically developed group and 46% of the children with disability. Mild disability was predominant (66.7%), followed by moderate disability (28.6%). The most commonly reported disability was hearing impairment (36.5%), followed by vision impairment/blindness (33.3%). Notably, 47.6% of the children with disabilities required an assistive device. The detailed demographic characteristics are presented in Table 1.

Table 1.

Baseline Characteristics of the Study Groups

Item	Children without disabilities (n=139)	Children with disabilities (n=63)
The participant
Father	20 (14.4%)	16 (25.4%)
Mother	67 (48.2%)	42 (66.7%)
Child	52 (37.4%)	5 (7.9%)
Child gender
Male	81 (58.3%)	34 (54%)
Female	58 (41.7%)	29 (46%)
Child Age (years)
8 – 10	55 (39.6%)	18 (28.6%)
11 – 13	31 (22.3%)	24 (38.1%)
14 – 16	17 (12.2%)	13 (20.6%)
17 – 18	36 (25.9%)	8 (12.7%)
Parent’s marital status
Married	129 (92.8%)	47 (74.6%)
Divorced	9 (6.5%)	12 (19%)
Widowed	1 (0.7%)	4 (6.3%)
Economic status of the family
≤5000 SAR/month	11 (7.9%)	15 (23.8%)
5001 – 18000 SAR/month	70 (50.4%)	29 (46%)
18001 – 30000 SAR/month	15 (10.8%)	16 (25.4%)
>30000 SAR/month	7 (5%)	2 (3.2%)
I don’t know	36 (25.9%)	1 (1.6%)
Type of education
Government	84 (60.4%)	41 (65.1%)
Private	55 (39.6%)	22 (34.9%)
Child’s educational level
Grade 1 - 3	25 (18%)	20 (31.7%)
Grade 4 - 6	44 (31.7%)	18 (28.6%)
Grade 7 – 9	25 (18%)	17 (27%)
Grade 10 - 12	45 (32.4%)	8 (12.7%)
The severity of disability
Mild	NA	42 (66.7%)
Moderate	NA	18 (28.6%)
Severe	NA	3 (4.8%)
Types of disability	NA
Vision impairment/blindness	NA	21 (33.3%)
Hearing impairment	NA	23 (36.5%)
Spinal disease	NA	2 (3.2%)
Upper limb paralysis	NA	2 (3.2%)
Lower limb paralysis	NA	6 (9.5%)
Other	NA	9 (14.3%)
The use of assistive device	NA
None	NA	33 (52.4%)
Hearing aids	NA	15 (23.8%)
Wheelchair	NA	9 (14.3%)
Crutches	NA	2 (3.2%)
Prostheses	NA	4 (6.3%)

Numerical data are presented as mean ± SD and categorical data are presented as frequencies (%). NA: Not applicable.

The total score of physical activity levels is demonstrated through the PAQ-C in Table 2. Overall, the total physical activity score was slightly lower for children with disabilities than for those without disabilities, but the difference was not statistically significant (p=0.443). The total Rosenberg Self-Esteem Scale score was significantly lower among children with disabilities than among those without disabilities (p=0.001).

Table 2.

Total Score of Physical Activity Questionnaire (PAQ-C) and Rosenberg Self-Esteem Scale (RSES)

Item	Children without disabilities (n=139)	Children with disabilities (n=63)	P-value
Total score of PAQ-C	2.6 ± 0.65	2.51 ± 0.85	0.443
Total score of RSES	31.65 ± 5.5	29.32 ± 4.3	0.001

Numerical data are presented as mean ± SD, Statistical significance was set at P-value<0.05.

Pearson’s correlation analysis revealed a significant positive correlation between physical activity (PAQ-C) and self-esteem (RSES) scores among children with disabilities (r=0.286, p=0.023) and those without disabilities (r=0.263, p=0.002), as shown in Table 3.

Table 3.

Association Between Physical Activity Questionnaire (PAQ-C) and Rosenberg Self-Esteem Scale (RSES)

Item	PAQ-C
Item	r	P-value
RSES
Among children without disabilities	0.263	0.002
Among children with disabilities	0.286	0.023

Statistical significance was set at P-value<0.05.

In the univariate linear regression analysis, children with disabilities showed significantly lower RSES scores than other typically developed groups (coefficient =-2.33, 95% CI: -3.88 -0.78, p=0.003). Children within the age range (8 – 10 years old), those aged 11 – 13 years showed significantly lower scores than those aged 8–10 years (coefficient =-2.22, 95% CI: -4.06 to -0.38, p=0.018). Moreover, each unit increase in physical activity score was significantly associated with a 1.96 increase in self-esteem score (95% CI: 0.98 to 2.95, p=0.001), as detailed in Table 4.

Table 4.

Linear Regression Analysis for Factors Associated With Rosenberg Self-Esteem Scale (RSES)

Item	Univariate analysis			Multivariable analysis
Item	Coefficient	95%CI	P-value	Coefficient	95%CI	P-value
Children with disability
No	Ref			Ref
Yes	-2.33	-3.88 to -0.78	0.003	-1.39	-3.16 to 0.38	0.124
Child gender
Male	Ref			Ref
Female	0.32	-1.16 to 1.80	0.669	1.02	-0.47 to 2.51	0.179
Age (years)
8 – 10	Ref			Ref
11 – 13	-2.22	-4.06 to -0.38	0.018	-1.49	-3.65 to 0.67	0.175
14 – 16	-0.99	-3.22 to 1.25	0.385	-2.37	-5.65 to 0.91	0.156
17 – 18	-1.44	-3.41 to 0.52	0.150	-3.9	-7.64 to -0.17	0.040
Parent’s marital status
Married	Ref			Ref
Divorced	-0.26	-2.65 to 2.14	0.834	-0.05	-2.51 to 2.40	0.967
Widowed	-2.82	-7.53 to 1.89	0.240	-0.69	-5.56 to 4.17	0.778
Economic status of the family
≤5000 SAR/month	Ref			Ref
5001 – 18000 SAR/month	1.34	-0.93 to 3.61	0.245	0.65	-1.6 to 2.9	0.571
18001 – 30000 SAR/month	-1.19	-3.93 to 1.55	0.392	-1.31	-4.04 to 1.41	0.342
>30000 SR/month	-1.16	-5.14 to 2.82	0.566	-3.18	-7.18 to 0.82	0.118
I don’t know	0.62	-2.02 to 3.25	0.646	-0.42	-3.29 to 2.45	0.772
Child’s educational level
Grade 1 - 3	Ref			Ref
Grade 4 - 6	-0.44	-2.47 to 1.59	0.670	0.06	-2.1 to 2.21	0.959
Grade 7 – 9	-1.11	-3.34 to 1.12	0.327	0.31	-2.47 to 3.10	0.826
Grade 10 - 12	0.58	-1.52 to 2.69	0.585	4.17	0.28 to 8.06	0.036
Type of education
Government	Ref			Ref
Private	0.27	-1.23 to 1.78	0.719	0.07	-1.54 to 1.69	0.930
PAQ-C	1.96	0.98 to 2.95	<0.001	1.82	0.78 to 2.85	0.001

CI: Confidence interval, Statistical significance was set at P-value<0.05.

After adjusting for the included factors, as presented in Table 4, the 17 – 18 year-old group showed significantly lower RSE scores than the 8 – 10 year-old group (coefficient =-3.9, 95%CI: -7.64 to -0.17, p=0.04), and children in grades 10 – 12 had higher scores than those in grades 1 – 3 (coefficient =4.17, 95%CI: 0.28 to 8.06, p=0.036). Each 1 unit increase in physical activity score was significantly associated with an increase in self-esteem score by 1.82 (95%CI: 0.78 to 2.85, p=0.001).

4. Discussion

This study aimed to examine the differences in physical activity levels and self-esteem between children with and without physical disabilities and to assess the relationships among these variables. The participants’ demographic characteristics varied in this study. The majority of the participants who completed the questionnaire were mothers, consistent with the results of other studies indicating that mothers are commonly the primary caregivers in this population.^15,20

The findings showed that children with disabilities had lower mean physical activity (PA) scores than those without disabilities. However, the differences in PA levels between children with and without disability were not statistically significant. This finding is inconsistent with previous research that reported significantly lower physical activity levels in children with disabilities than in typically developing children.^4,6,21 These inconsistencies could be explained by the types of disabilities, social barriers, and limited accessibility. Moreover, the non-significant difference in PA among these study groups may be explained by the high prevalence of mild disability (66.7%) and sensory deficits (hearing and vision) in the children with disabilities. Children with mild physical disabilities may encounter fewer obstacles hindering their engagement in physical activity than those with severe physical or mental disability.^14,21

The study revealed significantly lower self-esteem scores among children with disabilities than among those without disabilities. This finding is in line with earlier research showing that children with physical disabilities or chronic illnesses are more likely to have low self-esteem.^22,23 However, disability status was not a significant predictor in the final multivariate model after adjusting for age, educational level, and physical activity. The high prevalence of sensory and mild disabilities within the disability subgroups may explain these findings. Nonetheless, children with disabilities are more likely to have low self-esteem because of difficulties in social interaction, stigmatization, and limited opportunities for peer engagement.²⁴ However, these findings should be interpreted with caution due to the relatively low internal consistency observed in this study for the RSES. The low internal consistency of the RSES in this study may be explained by the young age of some participants and their difficulties in understanding negatively worded items, particularly in self-administered questionnaires. Therefore, the significant association between physical activity and self-esteem should be interpreted with caution. Future research is encouraged to employ measurements with simplified wording tailored to children with and without disabilities.

In this study, neither parental marital status nor family economic status emerged as significant predictors of self-esteem in the multivariable analysis. This finding may be partly explained by the sociocultural context of the Arabic study population, where extended family support and strong social cohesion may reduce the differences related to marital status and income.^6,14,15 Nevertheless, parental marital status and socioeconomic background remain important demographics to consider when designing PA programs and are worth further investigation in the future studies.

However, a significant positive correlation was observed between physical activity and self-esteem in both groups. Notably, linear regression analysis further showed that physical activity was the most consistent independent predictor of self-esteem in both univariate and multivariate analyses. This finding indicates that higher physical activity levels are associated with increased self-esteem. Consistently, this correlation has been well established in previous research, where engagement in regular physical activity improves skills and social interaction and ultimately enhances self-esteem among children with and without disability.^3,10,11 Moreover, recent findings have shown that PA could improve mental well-being, confidence, and self-worth.^2,23 Therefore, promoting physical activity is important for all children regardless of the presence of disability. To improve the levels of physical activity among children with disabilities, social support and reinforcement of parental perception of their children’s health and ability to engage in physical activity are recommended.^14,15 Furthermore, creating a safe and supportive environment is essential to encourage the participation of children in PA.

There are some limitations to consider when interpreting the findings of this study. As the study design was cross-sectional, no causal relationship could be established between physical activity and self-esteem. A self-reported questionnaire was used to collect data, which may not reflect actual values due to recall and social desirability bias. Moreover, the results should be interpreted with caution due to the relatively low internal consistency of the RSES observed in this study. Furthermore, the small sample size may limit the generalizability of the findings. In addition, the disability group in this study was predominantly composed of children with mild disabilities and sensory impairments (hearing and vision), with relatively few participants experiencing severe physical disabilities. Therefore, the findings may not be generalizable to children with more severe physical or mental disabilities.

The results can help nurses and healthcare providers to understand the relationship between physical activity levels and self-esteem among children with and without disabilities. The implications for practice include emphasizing the importance of physical activity for children’s overall health and self-esteem, reinforcing parents' and educators' efforts to encourage regular participation in physical activity, and enhancing the accessibility of physical activity for children with physical or sensory disabilities. Moreover, the findings of this study can inform the development of recreational programs that promote physical activity and well-being among children. Future research can use the findings from this study to develop tailored intervention programs for both groups of children to assess and improve their physical activity levels, and eventually their self-esteem.

5. Conclusions

This study concluded that children with disabilities have lower self-esteem than those without disabilities. The findings showed that self-esteem levels were significantly associated with physical activity, even after adjustments. Therefore, it is important to promote and improve the level of physical activity among children and to facilitate access to supportive and safe environments. The findings of this study can be used by healthcare professionals and educators to create tailored programs to support and encourage engagement in physical activity.

Footnotes

ORCID iD

Salmah A. Alghamdi

Ethical Considerations

The studies involving humans were approved by the Research Ethics Committee of the Faculty of Nursing, King Abdulaziz University (Ref No. 2F.116, approval date: April 29, 2025). The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. All methods were performed in accordance with the relevant guidelines and regulations.

Author Contributions

The author confirms sole responsibility for the following: study conception and design, data collection, analysis and interpretation of results, and manuscript preparation.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was funded by the Deanship of Scientific Research (DSR) at King Abdulaziz University, Jeddah, Saudi Arabia under grant no. (IPP: 153-668-2025). The author, therefore, acknowledges with thanks DSR for technical and financial support.

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The datasets presented in this article are not readily available to maintain confidentiality. Requests to access the datasets should be directed to saalghamdi6@kau.edu.

References

World Health Organization . Physical activity. Available online: https://www.who.int/news-room/fact-sheets/detail/physical-activity. accessed on 30 November 2025.

Wang

. The effects of physical activity on the mental health of typically developing children and adolescents: A systematic review and meta-analysis. BMC Public Health. 2025;25(1):1514. doi:10.1186/s12889-025-22690-8

Zheng

Yao

Zhou

Liu

. The effect of physical activity on the quality of life of athletes with disabilities and the mediating role of life satisfaction and physical self-esteem. Acta Psychol. 2023;240:104044. doi:10.1016/j.actpsy.2023.104044

Hinckson

Curtis

. Measuring physical activity in children and youth living with intellectual disabilities: A systematic review. Res Dev Disabil 2013;34(1):72-86. doi:10.1016/j.ridd.2012.07.022

Centers for Disease Control and Prevention . Disability and health overview. U.S. Department of Health & Human Services. Available online: https://www.cdc.gov/disability-and-health/about/index.html. accessed on 30 November 2025.

Columna

Prieto

Elias-Revolledo

Haegele

. The perspectives of parents of youth with disabilities toward physical activity: A systematic review. Disabil Health J. 2020;13(1):100851. doi:10.1016/j.dhjo.2019.100851

Szcześniak

Mazur

Rodzeń

Szpunar

. Influence of life satisfaction on self-esteem among young adults: The mediating role of self-presentation. Psychol Res Behav Manage 2021;14:1473-1482. doi:10.2147/PRBM.S322788

Rosenberg

. Society and the Adolescent Self-Image. Princeton University Press; 1965.

Nguyen

Wright

Dedding

Pham

Bunders

. Low self-esteem and its association with anxiety, depression, and suicidal ideation in Vietnamese secondary school students: A cross-sectional study. Front Psychiatry. 2019;10:698. doi:10.3389/fpsyt.2019.00698

10.

Alhumaid

Said

. Increased physical activity, higher educational attainment, and the use of mobility aid are associated with self-esteem in people with physical disabilities. Front Psychol 2023;14:1072709. doi:10.3389/fpsyg.2023.1072709

11.

Biddle

SJH

Ciaccioni

Thomas

Vergeer

. Physical activity and mental health in children and adolescents: An updated review of reviews and an analysis of causality. Psychol Sport Exercise. 2019;42:146-155. doi:10.1016/j.psychsport.2018.08.011

12.

Fierro-Saldaña

Treviño-Villarreal

. Inclusion of Students With Disabilities in Physical Education: The Crossroads of Systemic Coherence. Phys Cult Sport Stud Res. 2024;107(1):37-47. doi:10.2478/pcssr-2025-0004

13.

Sung

Mahmoudkhani

. The Socio-Ecological Factors of Physical Activity Participation in Preschool-Aged Children with Disabilities. Healthcare (Basel). 2025;13(9):1081. doi:10.3390/healthcare13091081

14.

Alghamdi

Banakhar

Badr

Alsulami

. Physical activity among children with down syndrome: maternal perception. Int J Qual Stud Health Well-Being. 2021;16(1):1932701. doi:10.1080/17482631.2021.1932701

15.

Alghamdi

Alsaigh

. Determinants of physical activity among children with disabilities. Healthcare (Basel). 2023;11(4):494. doi:10.3390/healthcare11040494

16.

von Elm

Altman

Egger

Pocock

Gøtzsche

Vandenbroucke

, et al. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806-808.

17.

Faul

Erdfelder

Buchner

Lang

A.-G

. Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behav Res Methods. 2009;41:1149-1160.

18.

Kowalski

Crocker

PRE

Donen

. The physical activity questionnaire for older children (PAQ-C) and adolescents (PAQ-A) manual. University of Saskatchewan: Saskatoon; 2004.

19.

Ong

Chen

Chong

Chan

Tan

Lee

. Use of children-physical activity questionnaire (C-PAQ) and subjective global nutrition assessment (SGNA) in assessing physical activity level and nutritional status of children with special needs. Clin Nutr 2018;37:S244. doi:10.1016/j.clnu.2017.09.208

20.

Alghamdi

. The Attitude of Parents Toward Their Children Receiving the COVID-19 Vaccine. Children. 2022;9(9):1308. doi:10.3390/children9091308

21.

Liu

Hou

. Exploring Physical Activity in Children and Adolescents with Disabilities: A Bibliometric Review of Current Status, Guidelines, Perceived Barriers, and Facilitators and Future Directions. Healthcare. 2024;12(9):934. doi:10.3390/healthcare12090934

22.

Mushtaq

Anjum

Jameel

Iqbal

Shahid

Dastgir

MHA

. Stigma of Disability, Social Phobia and Self-Esteem in Adolescents With Physical Disability. J. Postgrad. Med. Inst 2020;34(2). Retrieved from. https://www.jpmi.org.pk/index.php/jpmi/article/view/2582

23.

Pinquart

. Self-esteem of children and adolescents with chronic illness: a meta-analysis. Child Care Health Dev. 2013;39(2):153-161. doi:10.1111/j.1365-2214.2012.01351.x

24.

Hao

. The influence of physical activity on the mental health of high school students: the chain mediating effects of social support and self-esteem. Sci Rep. 2025;15:27537. doi:10.1038/s41598-025-11952-5