Abstract
Objectives
Australia’s bid for the 2032 Paralympic Games included a commitment to increasing sport participation among people with disabilities by 500,000. Realising this legacy will require an accurate understanding of the composition of the Australian disability population – age, sex, disability type and disability severity – as well as current Para sport participation rates.
Design and methods
Collation and synthesis of publicly available data from the Australian Bureau of Statistics, the Australian Institute of Health and Welfare and Para sport master lists.
Results
Among 4.37M Australians with disability, 44.5 % were aged ≥65 yrs. Of those aged <65 yrs, the maximum population that could be eligible for Para sport comprise 529,800 with intellectual disability, 85,900 with sight loss, and 802,000 with physical disability. Many high-prevalence disability types are not eligible for Para sport (e.g., hearing loss = 1.07M; psychosocial disability = 1.14M) and sport may not be appropriate for other types (e.g., chronic pain/discomfort = 1.46M). Compared with others with disability, those with severe/profound disabilities are least active (17.4 % meet physical activity guidelines) and underrepresented in sport (3.2 % of Para athletes with physical impairment have high support needs).
Conclusions
Increasing participation in any form of physical activity – including Para sports and other sports – by 500,000 would be a more achievable and inclusive legacy goal than increasing sports participation alone. Such an approach would cater for high-prevalence disability groups for whom commencement of competitive sport may not be suitable (e.g., >65 yrs, chronic pain). To permit safe, effective engagement in sport/physical activity for individuals with severe impairments and high support needs, investment in development and implementation of specialised, evidence-based programs is required.
Keywords: Para sport, Brisbane 2032, Sport, Disability
1. Introduction
According to the most recent Survey of Disability Aging and Carers (SDAC), approximately 5.5M Australians (21.4 %) lived with disability in 2022 [1]. Disability is defined as “any limitation, restriction or impairment which restricts everyday activities and has lasted, or is likely to last for at least six months” [1, 2].
In 2032, Brisbane will host the Olympic and Paralympic Games Australia’s bid to host these two mega-events included a commitment to increase the number of people with disabilities participating in sport by 500,000 [3]. Sport is defined by the Australian Sports Commission (ASC) as “A human activity that involves physical exertion and skill as its primary focus, includes elements of competition or social participation, operates under formal rules and patterns of behaviour established through organisations, and is generally recognized as a sport” [4]. Sport is a subset of physical activity, an umbrella term for “any bodily movement produced by skeletal muscle that results in energy expenditure” [4].
The target of 500,000 more participants is the most ambitious attempt to increase sport participation among people living with disabilities in Australian history and the commitment has since been reiterated by the Federal Government [5]. Importantly, in addition to creating a more inclusive society, achieving the targeted increase would yield a range of additional health and wellbeing benefits. For example, compared with other Australians, people with disability are 60 % less likely to meet the national physical activity guidelines – at least 150 min of moderate-intensity aerobic activity per week [6]. Consequently, they have an age-adjusted increase in potentially avoidable deaths of 3.6 times [7]. Through sports participation, people with disabilities can not only accrue the physical activity required for disease prevention – sport also provides people with disability with a sustainable, self-directed avenue for enhancing physical functioning, reducing social isolation and for pursuing excellence that is valued by their peers and the wider community [8,9].
While the Olympic Games is considerably larger than the Paralympic Games, the latter has an exclusive focus on people with disabilities and is therefore identified in the bid document as the primary driver for increasing sports participation identified [3]. However leveraging the Paralympic Games to promote sports participation across the disability community presents two unique challenges, both stemming from the fact that disability is a multidimensional construct, varying in terms of type (e.g., physical, intellectual, sensory) and severity (e.g., mild, moderate, severe, or profound) [2].
Firstly, all the sports contested at the Paralympic Games are Para sports. The word ‘Para’ is a registered trademark of the International Paralympic Committee (IPC) [10] and Para sport competitions are restricted to people who have one of 10 eligible impairment (or disability) types. Furthermore, the impairment must meet sports-specific minimum impairment criteria [11]. Para sports are a subset of disability sports, a term that encompasses any sport designed for or practiced by people with disabilities [12] such as those governed by Special Olympics, Invictus Games Foundation and the International Committee on Sports for the Deaf. Of all the Australian’s who are eligible for any form of disability sport, those who are eligible to compete in recognised Para sport events – at local, state, national or international level, including the Paralympic Games – are a smaller subset, comprised of only those who have impairments that meet the Para sport eligibility criteria. The challenge this presents is how best to leverage the Paralympic Games to promote sports participation among people with disabilities who are not eligible to compete in Para sport.
Secondly, the type and severity of a person’s disability will interact with their age and sex to determine the infrastructure, staffing and adaptations required to promote their safe, successful sports participation. To illustrate, the program requirements for older adults with a vision impairment will be very different from those of young autistic children with delayed motor development.
Given these challenges, it follows that effective leveraging of the Games requires an accurate understanding of the composition of the Australian disability population in terms of age, sex, disability type and disability severity in order to address questions of fundamental strategic importance, including [1]: what is the total number of people that may be eligible for Para sport?; [2]; what is their age and sex distribution?; [3]; what is the total number of people who cannot be eligible for Para sport?; and [4] how can the impact of the Games be maximised for people who have disability but who are not eligible for Para sport? Baseline data will also be important, including how many Australians with disability are currently physically active and how many Para athletes there are in Australia.
Accordingly, this study aimed to source authoritative, publicly available data to provide an overview of the age, sex, disability type and disability severity of [1] people with disability in Australia [2]; people with disability who are physically active; and [3] Australian Para-athletes.
2. Methods
2.1. Data sources
All data were drawn from three authoritative, publicly available sources. Individuals were not identifiable, so ethical approval was not sought. The primary source for age, sex, disability type and disability severity the “Survey of Disability, Ageing and Carers, Australia” (SDAC)”, published by the Australian Bureau of Statistics (ABS), the central statistical authority for the Australian Government [2]. These data were current at the time the legacy commitment were made (2021). In 2022, disaggregated forms of these primary data were combined with other primary data sources and presented in “People with disability in Australia 2022” [6]. The publisher, the Australian Institute of Health and Welfare (AIHW), is an independent statutory Australian government agency whose role is to provide meaningful information and statistics for the benefit of Australian people.
The total number of people competing in Para sport in Australia were obtained from the Australian or International organisation responsible for each of the 28 Paralympic sports – 22 Summer and 6 Winter. Specifically, each sport maintains a master list of athletes with a classification and, as athletes must have a classification in order to compete in Para sport, master lists provide a valid proxy for the number of competing athletes. Sources are presented as Supplementary Digital Material (see Appendix 1).
2.2. Data extraction and presentation
Sex was presented exactly as extracted – male or female – for all three datasets. Age was extracted and presented as closely as possible to developmental stages relevant to sport and other physical activities [13,14] as follows: early childhood (0–4 years), middle childhood (5–14 years), youth (15–24 years), adulthood (25–64 years) and older adulthood (65 years+). The extent to which this was possible varied depending on the data source – ABS, AIHW and Para Sport Master Lists.
Disability type was not extracted from ABS data but from AIHW data [6] and was presented as extracted. It had two levels of classification, the upper level comprising Physical (with eight subtypes), Intellectual (one subtype), Sensory or Speech (three subtypes), Psychosocial (four subtypes) and Head Injury/Stroke/ABI (one subtype). Data from Para Sport Master Lists were divided into Physical, Vision and Intellectual as indicated by sport class.
Disability severity data was presented as extracted for ABS [2] and AIHW [6] and had four fundamental levels summarised as follows: profound activity limitation – the person is unable to do or always needs help with one or more of the core activities (mobility, self-care and communication); severe activity limitation – the person sometimes needs help with one or more core activities and/or has difficulty with communication (e.g., being understood by family or friends); moderate activity limitation – the person needs no help but has difficulty with one or more core activities; and mild – the person needs no help and has no difficulty with any of the core activity tasks but uses aids or equipment.
Disability severity for data from Para Sport Master Lists was based on a published International Paralympic Committee convention, which provides a guideline for dividing all classes into two broad types: those for athletes with high support needs; and athletes without high support needs [15].
2.3. Data accuracy
ABS calculates a relative standard error (RSE) for all population estimates, expressed as a percentage of the estimate. ABS considers estimates reliable when RSE <25 %, and advises that estimates with a RSE of 25–50 % or >50 % should be used with caution [2] and the latter are indicated in the results tables.
To protect the privacy of individuals completing their surveys, the ABS uses a perturbation process which involves a small, random adjustment of the data within the confidence limits of the estimate and as a consequence minor discrepancies may exist between sums of the component items and totals [16].
Once data had been extracted and organised for presentation as described, it was cross checked independently by at least one person to ensure fidelity.
3. Results
Table 1 presents data from the ABS on disability prevalence by age, severity and sex [2]. Of the estimated 4.37M Australians with disability, 3.86M (88.4 %) have specific limitations or restrictions and the remaining 0.51M have no specific limitations or restrictions (i.e., disability does not affect core activities or participation in schooling/employment). Nearly half (44.5 %) of all people with disability are aged >65 yrs (N = 1.94M). An additional 40.8 % are aged 25–64 years (N = 1.78 M). In relative terms, the number of children aged 0–14 with disability is small – 8.2 % (0.36 million), comprising 57,000 (1.3 %) aged 0–4 years and 299,000 (6.9 %) aged 5–14 years.
Table 1.
Prevalence of disability, by disability severity sex and age [2].
| Sex/Age | Mild core activity limitation Est ‘000 (%) |
Moderate core activity limitation Est ‘000 (%) |
Severe core activity limitation Est ‘000 (%) |
Profound core activity limitation Est ‘000 (%) |
All with specific limitations or restrictions Est ‘000 (%) |
All with reported disability Est ‘000 (%) |
|---|---|---|---|---|---|---|
| All people | ||||||
| 0–4 yrs | 1.6 (0.0)∗∗ | 0.8 (0.0)∗∗ | 10.7 (0.3) | 25.7 (0.6) | 37.5 (0.9) | 57.8 (1.3) |
| 5–14 yrs | 59.4 (1.4) | 7.4 (0.2)∗ | 74.5 (1.7) | 100.3 (2.3) | 276.4 (6.3) | 299.2 (6.9) |
| 15–24 yrs | 73.4 (1.7) | 14.5 (0.3) | 63.0 (1.4) | 43.8 (1.0) | 254.3 (5.8) | 290.6 (6.7) |
| 25–64 yrs | 592.3 (13.6) | 287.7 (6.6) | 246.8 (5.7) | 167.4 (3.8) | 1512. (34.6) | 1780.0 (40.8) |
| 65 yrs+ | 778.9 (17.8) | 292.8 (6.7) | 239.2 (5.5) | 447.0 (10.2) | 1777.5 (40.7) | 1942.7 (44.5) |
| Total | 1507.4 (34.5) | 601.4 (13.8) | 632.9 (14.5) | 780.2 (17.9) | 3858.8 (88.4) | 4367.2 (100) |
| Females | ||||||
| 0–4 yrs | 1.7 (0.0)∗∗ | 0.0 (0.0) | 0.3 (0.0)∗∗ | 5.3 (0.1)∗ | 13.1 (0.3) | 20.2 (0.5) |
| 5–14 yrs | 24.7 (0.6) | 4.8 (0.1)∗ | 24.6 (0.6) | 30.6 (0.7) | 96.8 (2.2) | 107.7 (2.5) |
| 15–24 yrs | 36.7 (0.8) | 10.9 (0.2) | 29.6 (0.7) | 20.0 (0.5) | 126.0 (2.9) | 144.8 (3.3) |
| 25–64 yrs | 301.3 (6.9) | 158.7 (3.6) | 131.8 (3.0) | 83.7 (1.9) | 781.3 (17.9) | 916.2 (21.0) |
| 65 yrs+ | 370.0 (8.5) | 165.6 (3.8) | 131.3 (3.0) | 283.8 (6.5) | 959.4 (22.0) | 1034.4 (23.7) |
| Total | 735.8 (16.8) | 337.4 (7.7) | 321.8 (7.4) | 425.4 (9.7) | 1972.5 (45.2) | 2224.2 (50.9) |
| Males | ||||||
| 0–4 yrs | 1.5 (0.0)∗∗ | 0.0 (0.0) | 7.3 (0.2)∗∗ | 18.7 (0.4) | 26.2 (0.6) | 38.1 (0.9) |
| 5–14 yrs | 37.9 (0.9) | 2.8 (0.1)∗∗ | 49.9 (1.1) | 69.3 (1.6) | 178.8 (4.1) | 191.1 (4.4) |
| 15–24 yrs | 34.2 (0.8) | 3.3 (0.1)∗ | 34.4 (0.8) | 23.8 (0.5) | 127.3 (2.9) | 146.8 (3.4) |
| 25–64 yrs | 287.6 (6.6) | 127.5 (2.9) | 115.0 (2.6) | 81.8 (1.9) | 730.8 (16.7) | 864.8 (19.8) |
| 65 yrs+ | 412.2 (9.4) | 126.9 (2.9) | 106.2 (2.4) | 163.6 (3.7) | 819.5 (18.8) | 905.7 (20.7) |
| Total | 769.6 (17.6) | 264.7 (6.1) | 311.2 (7.1) | 355.0 (8.1) | 1886.1 (43.2) | 2144.0 (49.1) |
Note: Age groups 0–4 yrs, 5–14 yrs, and 15–24 yrs extracted directly from the ABS; age groups 25–64 yrs and 65 yrs + summed from component 10 year age bands. Percentages based on all people with disability (i.e., 4,367,200). The sum of component items may not match totals due to ABS perturbation procedure (see Methods).
Mild core activity limitation = No need for help and no difficulty, but uses aids or has limitations with core activities.
Moderate core activity limitation = No need for help but has difficulty with core activities.
Severe core activity limitation = Needs help sometimes or has difficulty with a core activity.
Profound core activity limitation = Greatest need for help (i.e., always needs help) with at least one core activity.
All with specific limitations or restrictions = All with core activity limitation (mild, moderate, severe or profound) + persons without core activity limitations but with schooling or employment restrictions.
=Relative standard error 25–50 %.
=Relative standard error > 50 %.
The total number of males (49.1 %) and females (50.9 %) with disability are similar as are the individual age categories where the differences are <3 % with one exception: in the age category 5–14 years, 64 % are males (N = 191,100) compared with 36 % females (N = 107,700). The number of males and females with disability aged <65 years is similar for males (1.24M) and females (1.19M), a total of 2.43M people.
People with profound (N = 0.78M) and severe core activity limitations (N = 0.63M) comprise 32.4 % of all people with disability and 30.2 % of all aged <65 years. This compares with those with mild (N = 1.51M) and moderate (N = 0.60M) core activity limitations who comprise 48.3 % of all people with disability and 42.7 % of all aged <65 years.
Table 2 presents disability disaggregated into six types: Sensory or speech; Intellectual; Physical; Psychosocial; Head injury/stroke/acquired brain injury (ABI); and Other not specified. Three of these types are further classified into subtypes – Sensory or speech is broken into three subtypes, physical into eight and psychosocial into four.
Table 2.
Prevalence of disability type and sub-type presented by age [6].
| Disability type | Aged 0–24 |
Aged 25–64 |
Aged 65+ |
Total |
|||||
|---|---|---|---|---|---|---|---|---|---|
| Disability sub-type/descriptor | Est ('000) | % | Est ('000) | % | Est ('000) | % | Est ('000) | % | |
| Sensory or speech | Loss of sight | 17.3 | 0.4 | 68.6 | 1.6 | 169.3 | 3.9 | 253.8 | 5.8 |
| Loss of hearing | 28.2 | 0.6 | 245.8 | 5.6 | 799.5 | 18.3 | 1072.4 | 24.6 | |
| Speech difficulties | 168.7 | 3.9 | 62.1 | 1.4 | 103.9 | 2.4 | 334.8 | 7.7 | |
| Total with sensory and speech | 214.2 | 4.9 | 369.0 | 8.4 | 968.5 | 22.2 | 1536.4 | 35.2 | |
| Intellectual | N/A | 328.5 | 7.5 | 201.3 | 4.6 | 198.7 | 4.5 | 730.3 | 16.7 |
| Physical | Breathing difficulties | 23.3 | 0.5 | 149.4 | 3.4 | 255.7 | 5.9 | 430.9 | 9.9 |
| Chronic or recurring pain or discomfort | 38.6 | 0.9 | 703.5 | 16.1 | 714.9 | 16.4 | 1457.6 | 33.4 | |
| Blackouts, seizures or loss of consciousness | 48.3 | 1.1 | 97.8 | 2.2 | 86.9 | 2.0 | 233.2 | 5.3 | |
| Incomplete use of arms or fingers | 21.8 | 0.5 | 151.3 | 3.5 | 214.3 | 4.9 | 388.2 | 8.9 | |
| Difficulty gripping or holding things | 46.8 | 1.1 | 348.8 | 8.0 | 510.3 | 11.7 | 904.9 | 20.7 | |
| Incomplete use of feet or legs | 26.0 | 0.6 | 207.3 | 4.7 | 362.9 | 8.3 | 597.8 | 13.7 | |
| Restriction in physical activities or work | 74.8 | 1.7 | 707.0 | 16.2 | 891.7 | 20.4 | 1674.7 | 38.3 | |
| Disfigurement or deformity | 30.8 | 0.7 | 88.6 | 2.0 | 88.2 | 2.0 | 206.2 | 4.7 | |
| Total with physical | 193.1 | 4.4 | 1199.2 | 27.5 | 1385.0 | 31.7 | 2782.2 | 63.7 | |
| Psycho-social | Nervous or emotional condition | 127.6 | 2.9 | 358.0 | 8.2 | 148.6 | 3.4 | 632.5 | 14.5 |
| Mental illness | 135.2 | 3.1 | 143.5 | 3.3 | 168.3 | 3.9 | 445.0 | 10.2 | |
| Memory problems or periods of confusion | 43.5 | 1.0 | 159.2 | 3.6 | 225.9 | 5.2 | 428.7 | 9.8 | |
| Social or behavioural difficulties | 164.9 | 3.8 | 175.1 | 4.0 | 115.1 | 2.6 | 455.7 | 10.4 | |
| Total with psychosocial | 269.5 | 6.2 | 511.2 | 11.7 | 357.2 | 8.2 | 1137.8 | 26.1 | |
| ABI | N/A | 24.6 | 0.6 | 152.6 | 3.5 | 147.5 | 3.4 | 323.2 | 7.4 |
| Other | N/A | 153.8 | 3.5 | 820.4 | 18.8 | 828.8 | 19.0 | 1805.8 | 41.3 |
| Total | Total with disability | 649.2 | 14.9 | 1778.8 | 40.7 | 1941.5 | 44.5 | 4367.2 | 100.0 |
ABI = Head injury, stroke or other acquired brain injury; Other = Other disability type(s) not specified; N/A = Not Applicable.
1 People are counted for each disability type reported and for each disability subtype they report (i.e., one person may report multiple disability types and subtypes). Consequently, sum of sub-types does not equal the total of Disability Type (e.g. Total with Physical does not equal the sum of all Physical sub-types); and Total with Disability does not equal the sum of all the Disability Types.
2 Because numbers are rounded and because of the perturbation process used by ABS to preserve confidentiality (see Methods), numbers and percentages reported in this table may differ slightly from those published by the ABS in other tables.
3 All percentages are calculated based on total number of people with disability (N = 4,367,200).
The most commonly reported disability type was physical (N = 2.78M, 63.7 % of all people with disability). Next, in order were sensory or speech (N = 1.54M, 35.2 %), psychosocial (N = 1.14M, 26.1 %), intellectual (N = 0.75M, 17.1 %), and head injury/stroke/ABI (N = 0.32M, 7.4 %).
Among people who reported physical disabilities, the most common were restriction in physical activities or work (1.67M, 38.3 % of all with disability) and chronic or recurring pain or discomfort (1.46M, 33.4 % of all with disability). People were able to report up to three types of motor disabilities: incomplete use of arms or fingers (388,200; 8.9 %); difficulty gripping or holding things (904,900; 20.7 % of people with disabilities); and incomplete use of feet or legs (597,800; 13.7 % of people with disabilities). Just under half of the reports – 42 % (0.80M) – were from people aged <65 years.
Among the reports of sensory or speech disability, 253,800 people reported loss of sight and of those 85,900 people (2.0 % of all people with disability) were aged <65 years. Loss of hearing was reported by 1.07M people and of those, 274,000 (6.3 % of all people with disability) were aged <65years.
3.1. Physical activity participation
Table 3 presents prevalence of all persons with disability meeting the physical activity guidelines by age, sex, and disability severity. Approximately 28 % (95 % CI 26.4–29.6; N = 126,800) of people with disability aged >15 years met the physical activity guidelines comprising 17.4 % (95 % CI 13.8–21.0; N = 145,000) of people with a severe or profound core activity limitation and 30.4 % (95 % CI 28.6–32.3; N = 1,115,900) of people with other disability status. Compared with people aged 15–64 yrs, the percentage of people meeting guidelines was approximately halved among people aged >65 years: when activity limitation was severe/profound (11.3 %, 95 % CI 7.5–15.1 vs 22.1 %, 95 % CI 16.7–27.5); for other disability status (18.9 %, 95 % CI 16.5–21.2 vs 37.1 %, 95 % CI 34.5–39.7); and overall (17.2 %, 95 % CI 15.4–19.1 vs 34.6 %, 95 % CI 32.2–36.9). In relation to males and females, there was considerable overlap in the 95%CIs for the percentage estimates of males and females with severe/profound activity limitations meeting guidelines, but a higher percentage of males with other disability status met guidelines compared with females (34.2 %, 95 % CI 30.9–37.5 vs 27.2 %, 95 % CI 24.8–29.7).
Table 3.
Prevalence of all persons with disability meeting the physical activity guideline by age, sex, and disability severity age [6].
| Sex | Age | Severe/profound activity limitation |
Other disability status |
All with disability |
|||
|---|---|---|---|---|---|---|---|
| Est ‘000 (%) | 95 % CI | Est ‘000 (%) | 95 % CI | Est ‘000 (%) | 95 % CI | ||
| All people | ≥15 yrs | 145.0 (17.4) | (13.8–21.0) | 1115.9 (30.4) | (28.6–32.3) | 1260.8 (28.0) | (26.4–29.6) |
| 15–64 yrs | 104.2 (22.1) | (16.7–27.5) | 863.2 (37.1) | (34.5–39.7) | 967.5 (34.6) | (32.2–36.9) | |
| ≥65 yrs | 40.7 (11.3) | (7.5–15.1) | 252.7 (18.9) | (16.5–21.2) | 293.4 (17.2) | (15.4–19.1) | |
| Females | ≥15 yrs | 80.8 (15.9) | (11.7–20.2) | 537.5 (27.2) | (24.8–29.7) | 618.3 (24.9) | (22.7–27.1) |
| Males | ≥15 yrs | 64.1 (19.7) | (13.9–25.4) | 578.4 (34.2) | (30.9–37.5) | 642.5 (31.9) | (29.1–34.6) |
Severe/Profound core activity limitation: sometimes or always needing assistance or support with core activities.
Other disability status: Disability with core activity limitations other than severe or profound.
Percentage indicates the percentage of a given population that meet physical activity guidelines. For example, of all males aged 15 yrs + who have severe/profound disability, 19.7 % met the physical activity guidelines.
3.2. Para sport participation
There are a maximum of 10,017 Australian athletes with a Para sport classification – 3674 (36.7 %) female and 6054 (60.4 %) male (see Table 4). Sex was unspecified for 289 (2.9 %), although whether this was intentional or unintentional was unclear (full breakdown of distribution in Supplementary Digital Material, Appendix 2).
Table 4.
Estimated maximum∗ number of Para athletes in Australia by sex, age, sport, and disability severity∗∗.
NS – Not specified; Sex was not specified by 289 (2.9 %) athletes and a full breakdown of their distribution – sports and ages – is available in Supplementary Digital Material (see Appendix 2).
Percentages represent, respectively: percentage of athletics athletes (denominator = 4601); percentage of swimming athletes (denominator = 3763); percentage of athletes in other sports (denominator = 1653); percentage of total athletes (denominator = 10,017).
The estimate represents a maximum that may be lower by an indeterminate proportion because some athletes may be classified for more than one sport and because some athletes may be inactive/retired but not removed from the master list.
Data retrieved from publicly available master lists maintained by recognised Para sports organisations. A list of the Para sports, the governing body and the website where the master list is hosted is presented as Supplementary Digital Material (see Appendix 1).
This maximum will be lower by an indeterminate proportion because some athletes hold classifications in multiple sports and because some athletes may be inactive/retired remain on the master list. There are 4600 athletes (46.0 %) with physical impairments comprising 317 (3.2 %) athletes with HSN and 4283 (42.8 %) other status. Athletes with intellectual impairment are next largest (N = 4692; 46.8 %) followed by vision impairment (N = 725; 7.2 %) comprising 166 (1.7 %) HSN and 559 (5.6 %) other status.
Of the 10,017 classified athletes in Australia, 83.5 % (N = 8364) were classified in Athletics and Swimming. Athletics was the largest sport (N = 4601; 45.9 % of all athletes). Athletes with intellectual impairment were the largest impairment group in athletics (N = 2931; 63.7 % of athletics) although they only contest 6 Para Athletics events (3M; 3F). Athletes with physical impairments were next largest (N = 1487; 32.3 %), comprising 43 (0.9 %) athletes with HSN and 1444 (31.4 %) other status. Athletes with vision impairment (N = 183; 4.0 %) comprised 36 (0.8 %) athletes with HSN and 147 (3.2 %) other disability status.
Swimming comprised 3763 athletes (37.6 % of all athletes). Swimmers with physical impairments were the largest group (N = 1819; 48.3 %), comprising 35 (0.9 % of swimmers) swimmers with HSN and 1784 (47.4 % of swimmers) other status. Swimmers with intellectual impairment were next largest (N = 1761; 46.8 % of swimmers). Swimmers with vision impairment (N = 183; 4.9 %) comprised 48 (1.3 %) swimmers with HSN and 135 (3.6 %) other disability status.
4. Discussion
Increasing sports participation among people with disability by 500,000 would be an outstanding Paralympic legacy that could be expected to lead to important social, economic and health benefits. To achieve this legacy, this study provides information of critical importance in three key areas: the age and sex of people with disability; types of disability affecting people; and the severity of disability affecting people. This information can be used to ensure that the strategies employed to achieve this legacy are as effective and equitable as possible.
Age and sex of people with disability: Of the 4.37M Australians with disability, approximately 44.5 % are aged ≥65 yrs (Table 1) and more than 80 % do not meet physical activity guidelines (Table 3). As currently stated, the legacy goal is 500,000 more people with disabilities playing sport, but evidence indicates that sports uptake among older people with disabilities would be proportionally small – only 0.6 % (N = 57) of Para athletes in Australia are aged >65 yrs (Table 4). Furthermore, the focus on sport excludes, for example, moderate intensity walking, which is not a sport but which is the activity most commonly engaged in by people meeting guidelines (48.5 %) [17] and the first of the activities recommended in Physical Activity Guidelines for Older Australians (65 years and over) [18]. Together, this evidence suggests that if the aim of the legacy goal were broadened from “increasing sports participation” to “increasing e physical activity participation” among people with disability – which includes sport but is not limited to sport – then there would be greater freedom to develop strategies tailored specifically for older Australians with disabilities. In this way the legacy would become both more inclusive and more achievable.
According to Australia’s bid document, the focus on increasing sports participation was based on the notion that “of the 4.3M people with a disability in Australia, only one in four play sport but 75 % want to play sport” [3]. The same idea features prominently in PA’s 2023 Strategic Plan [19]. While the current sports participation rate – one in four – comes from the AusPlay Data Portal [20] the provenance of the statistic that 75 % of people with disabilities want to play sport is unclear. Unfortunately, based on the ABS data presented in Table 1, the claim does not seem plausible. Specifically, 75 % of the 4.37M Australians with disability is approximately 3.3M people. If children aged 0–4 are excluded (a reasonable adjustment), the claim requires that 100 % of people with a disability aged 5–64 yrs (2.4M people) want to play sport and that an additional 900,000 people with disability aged >65 yrs also want to play sport.
While the implausibility of the statistic may be disappointing for disability sport advocates, if public policy, including sports policy, is not based on data of known veracity – preferably peer-reviewed data from trusted sources that can be publicly scrutinised – there is an unacceptably high risk of misdirected strategies that will ultimately fail to deliver. Unless and until the claim that 75 % of people with disabilities want to play sport can be tested, it should not be used to inform 2032 Games legacy planning. The implausibility of the claim, together with the large percentage of people with disabilities aged >65 yrs, increases the strength of the case for broadening the legacy goal from promoting sport to promoting physical activity.
The age distribution of the population is also important for talent identification in Para sports. People reach their physical prime during their youth and young-adulthood and consequently talent identification (TID) programs such as “You for 2032” (see https://youfor2032.initiatives.qld.gov.au/) targets prospective Para athletes aged between 13 and 30yo. While the total number of Australians aged <65 yrs with disability is 2.43M (see Table 1), the total number aged 5–34 yrs is only 853,500 (see Supplementary Digital Material, Appendix 3), approximately 19.5 % of all people with disability and 3.5 % of the Australian population (see Table 1). This includes a large but indeterminate proportion of people who will not be eligible for Para sport (e.g., people with ineligible impairment types or not meeting minimum impairment criteria). Consequently, broad-based, population–level activities that work for the general population, but which rely on people making their own way to a central venue for a one-off testing session are unlikely to be successful. Strategies based on collaboration with established disability service providers (e.g., acute and community-based rehabilitation providers) and which provide young children with disabilities (0–12 years) with opportunities to participate in sport and other physical activities will have greater reach and better prospects of success.
Table 1 indicates that the total number of males (N = 2.14M; 49.1 %) and females (N = 2.22M; 50.9 %) with disability are roughly equivalent, as are numbers in the age brackets reported. This suggests that unequal prevalence of disability between males and females may not be a barrier to achieving equality of participation in general sport and other physical activities.
However, Table 3 indicates that a higher percentage of males with disabilities meet physical activity guidelines than females (31.9 %, 95 % CI 29.1–34.6 vs 24.9 %, 95 % CI 22.7–27.1) and Table 4 indicates that there are approximately 1.7 times more males than females with a Para sport classification (N = 6176; 61.2 % vs N = 3670; 36.4 %). It is possible that the high male:female ratio in Para sport may be due, at least in part, to the fact that many Para athletes are eligible for Para sport as a result of a catastrophic traumatic injury during their athletic prime (i.e., 13–30 yrs) and the incidence of such injuries – spinal cord injury, brain injury and amputation – is approximately 1.5–3.0 times higher among males than females during this life-stage [21,22].
Disability type: Among the 18 disability sub-types listed in Table 2, only people reporting at least one of the following five sub-types are eligible for Para sport: Intellectual; Sensory – loss of sight; Physical – incomplete use of arms or fingers; Physical – Difficulty gripping or holding things; and Physical – Incomplete use of feet or legs.
Although people with intellectual disability are eligible for the Games, they do not compete at the Winter Games and only contested 15 (2.7 %) of the 549 events on the 2024 Summer Paralympic Games program, in three sports – Para Athletics (3 events each for males and females), Para Swimming (3 events each for males and females and 1 relay) and Table Tennis (1 event each for males and females). However two other two well established international sports organisations provide a full program of events for people with Intellectual disability as well as autistic people: Virtus (https://www.virtus.sport/) which deliver the Global Games; and Special Olympics International (https://www.specialolympics.org/) which deliver the Special Olympics. Therefore, strategies to achieve the legacy goal will be most effective if promotion of sports participation among people with intellectual disability are not restricted to Para sport but include all disability sports and explicitly promote engagement in Special Olympics and Global Games programs from grassroots to international level.
Despite limited representation on the Games program, athletes with an intellectual impairment comprise 46.8 % of athletes with a Para sport classification (N = 4692), more than either physical or vision impairment (see Table 4). Several differences between people with intellectual disabilities and those with physical or vision impairments may explain this relatively high rate of classification: national-level classification of intellectual impairment does not require face-to-face evaluation by a specialist; physical access to facilities is less problematic; and performance levels, methods of assessment and equipment for athletes with intellectual disabilities are closer to those of people without disabilities, thereby facilitating their inclusion in non-disabled squads/programs.
The population of people with a vision impairment is relatively small (N = 253,800) and relatively older in age – only 6.8 % (N = 17,300) are aged <25 yrs and another 27.0 % (N = 68,600) are aged 25–64 years. Given the low incidence and specific accessibility needs of people with vision impairment, successful promotion of sports participation and talent identification/development for people with vision impairment will require a very targeted tailored strategy. It should incorporate formation of relationships between appropriately skilled providers (for example, allied health professionals as coaches) and organisations that already provide services to people with vision impairment (for example, Vision Australia and Guide Dogs Australia), the school system and programs with appropriate safety and teaching procedures for sports introduction and development. Pathways should cater for adaptations and adjustments required by people across the vision impairment spectrum, from no vision to low/some vision and include appropriate, sports-specific and aetiology-specific preparticipation screening.
People with physical disability may be eligible for Para sport if they report one or more of the following three subtypes (see Table 2): incomplete use of arms or fingers (N = 388.2); difficulty gripping or holding things (N = 904.9); or incomplete use of feet or legs (N = 597.8). The sum of these three subtypes is 1.89M and the sum of reports from people <65 yrs is 802,900 comprising 94,600 (5 %) aged <25 yrs and 707,400 (37.4 %) aged 25–64 yrs.
It is important note that people can report more than one disability type and/or subtype (e.g., a person with hemiplegic cerebral palsy GMFCS II may have difficulty gripping, incomplete use of arms and incomplete use of legs). Therefore, although the sum of the three sub-types reported by people <65 yrs is 802,900 (18.4 % of the 4.3M Australians with a disability), the total number of people who are eligible for Para sport will be lower by an appreciable but indeterminate proportion because: some people will be counted two or three times; some will not meet minimum impairment criteria; some are aged 0–5 yrs; and some will have multiple severe disabilities (e.g., a person with an advanced, progressive neurological condition who cannot propel a manual wheelchair) thereby either making Para sport engagement medically inadvisable or physically impossible.
Similar to people with vision impairment, the low incidence and unique accessibility needs of people with physical disabilities will require very targeted strategies to successfully promote broad-based sports participation and identify/develop talent. This includes engaging with appropriately skilled allied health providers and engaging with acute and community-based rehabilitation service providers, schools and community-based disability service providers.
Table 2 cannot provide an accurate estimate of the number of people with disability who will not be eligible for Para sport for reasons already explained (i.e., because people can report more than one disability type/subtype). However, it does indicate the number is large – anyone that does not have an eligible impairment (i.e., intellectual, visual or one of the three physical subtypes) will not be eligible. This includes any of the 1.07M people with hearing loss and no other disability; or any of the 1.14M with psychosocial disability (including autism spectrum disorder or ADHD) and no other disability. Therefore, strategies tailored for promoting participation in disability sport and adapted physical activity among people with high-prevalence disabilities who are not eligible for Para sport are required. For example, engaging with and supporting the broader, disability sports and adapted physical activity sector would provide more direct reach into: 1) those populations that are not eligible for Para sport (e.g., those catered for by Deaf Sports Australia); 2) those people with disabilities who want to participate or compete in non-Para disability sports (e.g., the full suite of sports offered by Dwarf Sports Association Australia or Disability Sports Australia); and 3) those people who prefer participation in contexts across the inclusion spectrum (e.g., programs offered by Sports inclusion Australia, Lifestream and the Modified Rugby Program).
Finally, adopting a new sport may not be suitable or appropriate for some other high-prevalence disability types/sub-types presented in Table 2 including some of the 1.46M with chronic pain or discomfort and/or the 1.67M who have physical disabilities that restrict work. This reinforces our previous observation – the envisioned Paralympic legacy would be more achievable and inclusive if it were broadened from a narrow focus on increasing sports participation to increasing the number of people with disabilities who meet national physical activity guidelines by 500,000.
Disability severity: People with severe or profound activity limitations comprise 32.4 % of people with disabilities (see Table 1) however only 17.4 % met physical activity guidelines, compared with 30.4 % of people with other disability status (Table 3). Athletes with high support needs are underrepresented in Para sport, particularly among athletes with a physical impairment: 46.0 % of all athletes with a Para sport classification have a physical impairment, but only 3.2 % have high support needs (see Table 4). Evidence indicates that the time-cost of participating in sport is significantly higher for people with severe impairments and high support needs [23], and that they are underrepresented in studies evaluating physical activity and disability [24]. However the evidence that does exist underscores the large and meaningful improvements in physical [25] and psychosocial [26]domains conferred by engagement in sport and other physical activities.
Compared with those with other disability status, the challenges associated with increasing participation in sport and other physical activities for people with severe impairments and high support needs are greater – they have more severe motor, sensory, behavioural and cognitive impairments which present an overall higher risk of adverse events that are medically significant, and which cannot be managed independently by community sport and recreation providers. It has recently been proposed that challenges associated with increased risk and others associated with increased need for adaptive equipment, personal support and individualised technique all require coordinated multi-professional guidance [25]. These challenges are significant and, if they are not addressed, well-intentioned efforts to increase participation will have the unintended consequence of amplifying inequity. Specifically, unless promotional strategies incorporate the required multiprofessional guidance and the necessary adapted equipment, the strategies will disproportionately increase participation among those with less severe impairments and effectively excluding the most vulnerable people with disabilities from the social, economic and health dividend conferred by the Games.
4.1. Limitations
As indicated in the methods, the data in Table 1 come from the 2019 SDAC rather than the most recent 2024 SDAC [1]. These data were preferred for two reasons: they were current at the time the legacy commitment were made (2021) and so provide the most relevant context; the data in Table 2 (presenting disability types and sub-types) and 3 (presenting physical activity participation rates) were published in 2022 by AIHW and were based on disaggregation of the 2019 SDAC primary data combined with other primary data sources [6]. These data were central to the aims of our study and no such analyses have been conducted on the 2024 ABS data.
5. Conclusions
Increasing sports participation among people with disabilities by 500,000 would be an outstanding legacy of the 2032 Paralympic Games. However there is currently a maximum of ∼10,017 Para athletes in Australia and, of the 4.3M Australians with a disability, the number aged 5–34 years is small – only 853,500, or 3.5 % of the Australian population. Of these, only a small proportion will have a physical, vision or intellectual disability that is eligible for Para sport.
Therefore, while strategies for increasing Para sports participation are important, the legacy would be made more achievable and inclusive by:
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Broadening it to include increasing “physical activity participants” – rather than “sports participants” – by 500,000. This would attract high-prevalence disability groups for whom competitive sport may not suitable such as those >65 yrs (N = 1.94M) and who have chronic pain (N = 1.46M); and
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Developing strategies for promoting sports participation among people with high-prevalence disabilities who are not eligible for Para sport such as the deaf (N = 1.07M) and those with psychosocial disabilities (N = 1.14M).
Among people with disability, those with severe impairments and high support needs have the lowest rates of participation in physical activity and Para sport. In the interests of equity it will be critical to invest in the development and evaluation of evidence-based programs with the required multiprofessional support to address the challenging work of facilitating their safe, effective engagement in sport and other physical activities.
In relation to winning medals at the games, competition to gain representation appears very strong among athletes with intellectual disability – 4692 athletes competing for 15 events. However competition is extremely weak among athletes with PI-HSN (N = 317 athletes) and VI-HSN (N = 166 athletes) and strategies for attracting and retaining these athletes are urgently needed.
Practical implications.
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practitioners in sport, exercise and physical activity promotion should be aware that one of the 2032 Paralympic games legacy commitments made by Australia was to increase the number of people with disabilities participating in sport by 500,000, the most ambitious target in Australian history.
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strategies for achieving this increase are slowly emerging and we encourage professional associations and advocacy groups to carry the message that this valuable legacy goal will be more achievable and inclusive for people with disabilities if it is broadened from its current narrow focus on sports participation, to participation in any form of physical activity because: there are only approximately 10,000 Para athletes in Australia; 44 % of people with disabilities (1.94M) are aged >65 yrs and/or affected by chronic pain (1.46M).
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The total number of people with disabilities aged 5–34 years is relatively small – only 853,500, or 3.5 % of the Australian population. Of these, a smaller subset will have a physical, vision or intellectual disability that is eligible for Para sport. Consequently talent identification strategies for Para athletes cannot depend on those eligible athletes finding their way to large-scale, one-off testing events. More targeted, tailor strategies that maximise the reach of strategies – e.g., through schools and rehabilitation centres – are required.
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Among people with disabilities, those with severe-profound disabilities have particularly low rates of participation in sport and other physical activities and, in the interest of equity, are critical to invest in the development and evaluation of evidence-based programs to facilitate their safe and effective participation.
Declaration of competing interest
We have no interests to declare.
Footnotes
This article is part of a special issue entitled: PA for people living with disability published in JSAMS Plus.
Supplementary data to this article can be found online at https://doi.org/10.1016/j.jsampl.2025.100110.
Appendix A. Supplementary data
The following is the Supplementary data to this article:
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