Rapid Evidence Review: Improving opportunities for physical activity for care-experienced children and young people (September 2025)

This review presents the academic literature that informed the “Guidance on improving opportunities for physical activity for care-experienced children and young people” (LGA, 2025). It is designed to be read alongside the guidance, offering an evidence-based foundation to support councils and their partners in making informed decisions, and exploring areas of further interest for the council. Please note that while all available evidence has been carefully considered in the development of this Guidance, there may be differing interpretations. Councils are encouraged to review the evidence and apply their own judgement in context.

Definition of physical activity

We define physical activity as any bodily movement that requires energy use (for further information, see NICE, 2009). This includes: team and individual sports (such as – but not limited to – football, cricket or swimming); lifestyle activities (such as dance, boxing or yoga); and everyday forms of movement (such as walking, cycling, gardening, or household tasks).

Benefits of physical activity

Physical activity has wide-ranging benefits for children and young people (Janssen and LeBlack, 2010; Eime et al., 2015; Chaput et al., 2020). Physical activity can improve children and young people’s physical health through enhanced cardiorespiratory fitness, stronger bones and muscles, and weight control. Children and young people who are physically active are less likely to develop long-term health conditions as adults, such as Type 2 diabetes, heart disease, and some cancers. Positive habits developed early in life also increase the likelihood of an active lifestyle in adulthood. (Humphreys et al, 2014; UK Chief Medical Officers, 2019; World Health Organisation, 2024).

Physical activity can positively impact the mental health of children and young people by reducing symptoms of anxiety and depression, and improving mood (Biddle and Vergeer, 2020). Evidence suggests it can also boost their cognitive function and academic performance (Li et al, 2023; James et al 2023).

In addition, being physically active may help children and young people to build friendships and trusting relationships with others, and to develop ‘socio-emotional’ and ‘socio-moral’ skills and values, such as emotional resilience, leadership skills, and civic participation (Biddle and Vergeer, 2020; Sandford et al, 2021). Engagement in physical activities – including sport, recreation and leisure activities – can increase opportunities for education, employment, training and volunteering (Sport England, 2025; Bradford et al, 2016).

The NHS provides guidance on the type and amount of physical activity that children and young people should do each day to promote their physical and mental wellbeing (NHS, 2024). However, we know that activity rates in children and young people generally are low – with over half of children and young people not meeting the Chief Medical Officer’s guidelines of taking part in sport and physical activity for an average of at least 60 minutes every day (Sport England, 2023b). A lack of movement in childhood has been linked to negative physical and mental health outcomes (Chaput et al, 2020). 

Care-experienced children and young people and physical activity

A care-experienced person is anyone who, at any stage in their life and for any length of time, was cared for by someone other than their birth parents. This includes, for example, being looked after by foster carers, in a residential children’s home, with family or friends or in other arrangements including hospitals, supported accommodation or secure units. Someone who is adopted after being in care is also care experienced. This term also includes care leavers. A care leaver is a young person aged 16-25 years old who was previously in care and who is now entitled to ongoing support from their council.

All children, whether care-experienced or not, have the same needs for care and attention to support their development, including the development of physically active lives. For care-experienced children and young people this scaffolding must be provided by the care system. Many care-experienced children and young people have had difficult experiences prior to entering care, which may result in trauma (these experiences are sometimes called adverse childhood experiences – ACEs). Instability in the care system – such as frequent changes in placements, in schools, and in the people that care for them – can lead to further distress for children and young people. Without adequate support, care-experienced children and young people may be more likely to develop poor physical and mental health, and to experience emotional and behavioural difficulties that can affect learning, development, and their social relationships. This can lead to a range of social and health inequalities, including poorer educational outcomes, higher rates of special educational needs, emotional and mental health problems, and higher rates of homelessness and unemployment on leaving care. (RCPCH, 2023). 

However, academic literature suggests that care-experienced children and young people may benefit particularly from physical activity. With the right support, increased participation in physical activity can strengthen their physical and psychological well-being as well as support the development of their social capital, resilience and identity (Sandford et al, 2021).

There is currently no specific data available on physical activity rates among children and young people in the care system or care leavers. However, we do know that physical activity rates among children and young people in the general population are low (with recent findings from the Active Lives survey suggesting that fewer than half are meeting guidelines for physical activity; Sport England, 2024). We also know from a growing body of research that care-experienced children and young people face unique individual and systemic barriers to accessing and engaging in physical activity, which may further reduce participation rates. This review draws in particular on the work of Rachel Sandford, Thomas Quarmby and others – see e.g. the ‘Right to be Active’ (R2BA) project (Sandford et al, 2021).

Approach/ Methodology

We will present a summary of the academic literature on the barriers and enablers to accessing and engaging in physical activity for care-experienced children and young people.

We used the Google Scholar and EBSCOhost databases to find literature for this review. (We also searched the Adoption and Fostering journal separately). Two key research concepts were used:

1. care-experienced children and young people – search terms included ‘children in care’ ‘care’, ‘care experienced’, ‘children’, ‘young people’, ‘care leavers’, ‘foster care’, ‘kinship care’, ‘residential care’, and;
2. physical activity – search terms included ‘sport’, ‘exercise’, ‘physical activity’, ‘movement’. 

Searches were supplemented by input from the research team and steering group to incorporate known omissions as searches progressed. We only included literature written in English. As UK-specific research on this issue is limited, this review also draws on international research – where international evidence is used, it is highlighted in the text.

Some discussions of physical activity focus primarily on the individual, such as individual motivations and abilities to participate in physical activity. However, the concept of ‘physical literacy’ identifies that our relationship with movement and physical activity is influenced throughout our lives by individual, social and environmental factors (Sport England, 2023b).

 Based on the research literature, this review organises barriers and enablers into three levels:

1. the individual care-experienced child or young person;
2. social or interpersonal factors (reflecting children and young people’s interactions with others);
3. wider environmental or system-level factors. 

This review provides an overview of barriers and enablers mentioned in the research literature. The organising and ordering of barriers and enablers into these three levels does not imply anything about their relative importance. However, we comment below on the prevalence and significance of some barriers and enablers where this is supported by the research evidence. 

Additionally, barriers and enablers at the different levels are interlinked. For example: individual experiences of trauma may make it more challenging for some young people to participate in physical activity; trauma-informed practice by staff (e.g. PE teachers) may make physical activity more inclusive for care-experienced young people; and a system that recognises the need for trauma-informed practice will serve all young people better. The review looks at a range of contexts in which physical activity takes place, including in schools.

Impacts of trauma

With the right support, all care-experienced children can thrive. Such support needs to take into account the impacts of trauma that some children and young people experience before (and sometimes after) entering the care system. 

Trauma can be written into children and young people’s bodies in ways that potentially affect their capacity to engage in physical activity (meaning they require more support to participate). Research has begun to map some of the pathways by which adverse childhood experiences can affect children in this way – leading to increased levels of obesity and/or inflammation (Baldwin and Danese, 2019). When children’s bodies go through adverse experiences their bodies may adapt to increase their intake of energy, store more energy (as fat), and/or decrease their use of energy (by reducing their activity levels). 

Children who have experienced abuse or neglect tend to show reduced activity in certain ‘reward systems’ in their brains, and chronic over-activity in their ‘central stress response system’; this may lead to children and young people ‘self-medicating’ their bodies’ systems with high-calorie food (Baldwin and Danese, 2019). They may also experience changes in bodily hormones (such as ‘leptin’) which affect how their body uses energy. Their bodies may become less sensitive to the stress hormone ‘cortisol’, they may experience changes to their gut microbiome, and/or they may have disrupted sleep patterns. These changes can lead to chronic inflammation in their bodies, which causes fatigue (Baldwin and Danese, 2019). 

Research has found higher rates of obesity in care-experienced children (e.g. Dhindsa et al, 2020). Abused and neglected children have a higher risk of obesity as adults, and tend to have higher levels of inflammation in their bodies both in adolescence and adulthood (Baldwin and Danese, 2019). Outside of children directly experiencing abuse and neglect, it is likely that food poverty and challenging living conditions might affect children’s bodies in similar ways.

For some children and young people who are overweight or obese, certain activities may be more suitable or preferred. Some children with obesity may experience musculoskeletal pain or need to avoid high-impact exercise in favour of lower-impact options (Tsiros et al., 2021). Care-experienced children and young people may also have specific physical health challenges which mean they require more support to participate in physical activity. A recent study found that over a quarter of care leavers reported having a disability (Baker and Briheim-Crookall, 2024). Another study suggested that as many as two-thirds of care-experienced children in the UK had at least one physical health complaint, and care-experienced children and young people are more likely to experience problems such as coordination difficulties, eye or sight problems, and stiffness or deformity of limbs (Meltzer et al, 2003; Fitzgerald et al, 2014). Children with experience of care are more likely to have epilepsy, cystic fibrosis and cerebral palsy, and there may be significant unmet/unidentified needs as well (Martin et al, 2014). They may also have delayed or disrupted motor skills development (Quarmby et al, 2018a).

Across different physical disabilities, intellectual and learning disabilities, and sensory impairments – each child and young person's experience will be different. However, there is evidence for the benefits of physical activity across a range of conditions – and no evidence that physical activity presents an adverse risk for these children and young people (see Smith et al, 2022 for more detail). The Chief Medical Officers advise that children and young people with disabilities should take part in an average of 20 minutes of physical activity per day. Reduced participation in physical activity for children and young people with disabilities is not always a result of individual choice, but often a result of disablism, discrimination, and systemic inequalities (Smith et al, 2022). We discuss in the final section below some support that can be provided to overcome these barriers.

Mental health challenges may also present a barrier to participation in physical activity. Estimates of the prevalence of mental health challenges amongst care-experienced children vary widely but as many as 82 per cent of children in care have been reported to face such challenges (Cummings and Shelton, 2024). Beyond diagnosable mental health conditions, emotional factors have also been identified as barriers to engagement in physical activity. As well as affecting their opportunities to participate in physical activity, research shows that entering care (and the associated disruption of placement moves, school disruption, official meetings etc) can reduce some care-experienced children and young people’s interest and motivation to engage in physical activity (McLean and Penco, 2020; O'Donnell et al, 2019; Quarmby, 2014; Quarmby et al, 2020; Sandford et al, 2021; Whyte et al, 2024). However, care-experienced children and young people are not a homogenous group – in Sandford et al.’s (2021) survey of 49 care-experienced young people, 83 per cent reported that sport/physical activity was either ‘a little important’ or ‘very important’ to them.

Sometimes resulting from the adversity/trauma that they have experienced, care-experienced children and young people may struggle to engage because of challenges with confidence, shyness, isolation and a lack of friendships, challenges with social skills, challenges with ‘self-efficacy’, disaffection, or other emotional or behavioural challenges (McLean and Penco, 2020; Sandford et al., 2021; Whyte et al., 2024; Green et al., 2021; Quarmby et al, 2018a). Stress and fear can also be barriers to participation in physical activity , including fear of stigmatisation for ‘being different’ (Whyte et al., 2024;Sandford et al., 2021).

Benefits, enjoyment, and identity in physical activity

However, physical activity also has benefits to mental health and wellbeing, and these can be an enabler to ongoing participation. Participation in physical activity (including sport) can be a coping mechanism for care-experienced children and young people (Quarmby et al, 2020). Whilst other coping mechanisms (including substance use and ‘aggressive behaviour coping’) are linked to an increased likelihood of depression for young people, physical activity is linked with lower levels of depression (Goodwin, 2006; Fitzgerald et al. 2014). Physical activity can help some care-experienced children and young people to release ongoing anger, worry and stress. For example, research with Eritrean Unaccompanied Refugee Minors living in residential care in the Netherlands found that physical activities such as walking, football, cycling, and swimming helped participants to release daily stress, including financial worries and concerns about family (van Es et al, 2019). Physical activity can be a form of relaxation for care-experienced children and young people (Whyte et al, 2024). Taking part in physical activity can help to build resilience and can provide a sense of regularity, consistency, and stability (Sandford et al, 2021; Whyte et al, 2024).

Some physical activity provides access to nature – whether this is walking/running/cycling in nature or outdoor/adventure activity programmes for care-experienced children and young people. International research shows that being in nature can help care-experienced children and young people escape their everyday stressors and worries because they are given the physical, mental, and emotional space that comes with being in open, new, and fresh surroundings (Conlon et al, 2018; Haaland and Tønnessen, 2022).

Other benefits some care-experienced children and young people experience from physical activity may motivate them to continue taking part. These include improvements to their physical health, increased feelings of self-esteem, and feelings that they are achieving something, developing skills, or are achieving ‘excellence’ (Sandford et al, 2021; Quarmby et al., 2020).

A direct benefit and an enabler to taking part may of course be care-experienced children and young people’s enjoyment. Enjoyment is subjective, and personal taste, choice and preference may be a barrier or enabler depending on care-experienced children and young people’s individual dispositions (Sandford et al, 2021). In some cases, specific attitudes to physical activities (positive or negative) may relate to age, class, gender, race and culture; for example, some care-experienced young people may see running as an activity for middle-class people, or dance as an activity for females (Quarmby et al, 2020). Groups of children and young people also face additional barriers to participating in physical activity – for example girls and young women may have concerns about being harassed or observed whilst exercising (LGA, 2024). As these are systemic issues we consider them in the section on system-level barriers below.                                              

The concept of ‘physical literacy’ suggests that enjoyment, meaning and value are central to our relationship with physical activity (Sport England, 2023b). Activities that are meaningful for care-experienced children and young people – that is, activities which they enjoy and which resonate with their personal stories, or contribute to the development of their identity – may have particular appeal (Quarmby et al, 2020; Sandford et al, 2021). Quarmby et al. (2020) give an example of a young person who got into running after winning a race at a school sports day, and then found that running gave them the tools to deal with life.

Care-experienced children and young people may start behind others if they have not had enough physical activity in childhood (and not had the chance to develop ‘physical’ and ‘social capital’). They may have had limited opportunities to develop physical skills, they may not think of themselves as sporty, and they may not see themselves in a positive light in terms of physical activity – this can be a barrier for some (Quarmby et al, 2018a; McLean and Penco, 2020). In some physical activities there can be a pressure to be competent or a fear of being perceived as incompetent or stigmatised, and this may lead to avoidance and opting out (e.g. by not bringing PE kit to school). Social status may be linked to sporting ability, particularly for boys in ‘masculine’ ‘invasion’ games such as rugby or soccer (Quarmby et al, 2018a).

Experiences of physical activity including school sport

Other social aspects of physical activity may be off-putting to care-experienced children and young people. For example, school changing rooms may operate beyond teachers’ supervision and have their own power dynamics, which may involve the policing or normalisation of certain body types. Some care-experienced young people may find these spaces volatile or humiliating, and they may be particularly challenging for those who have experience of physical and/or sexual abuse, or visible signs of abuse or self-harm (Quarmby et al, 2018a). 

Some care-experienced children and young people may have strong negative feelings about PE and/or school sport – particularly if they are having a negative experience of school in general – and they may be more comfortable undertaking physical activity in other contexts such as gyms or out-of-school clubs (Ward, 2023; O'Donnell et al, 2019). For other care-experienced children and young people, PE/school sport may be a positive space – particularly when they have supportive staff and a chance to demonstrate their skills.

Other personal preferences

Personal preferences for structured or unstructured activities also vary. Having a structured context for physical activity (including organised activities and school-based sport) benefits some care-experienced children and young people in particular (Sandford et al, 2023). Others may prefer unstructured physical activity (such as walking and cycling, roller-skating, or playing in parks). Sandford et al. (2021) noted that some care-experienced children and young people found structured residential activities organised by local authorities too ‘official’ and saw them as forcing an inauthentic narrative of personal development. The age of care-experienced children and young people may be an important factor in their preferences as well.

All the individual-level barriers and enablers identified throughout this section above are specific and personal to each care-experienced child or young person (Bruce et al, 2019; Carless and Douglas, 2010; Sandford et al, 2021). For example, Haaland and Tønnessen (2022) conducted a study of care-experienced children and young people participating in outdoor recreational activities in Norway; they found that some young people developed feelings of self-worth, self-efficacy and positive thinking, but others experienced feelings of rejection and vulnerability. As we discuss below, listening to children and young people’s voices, identifying and paying attention to their individual needs and interests – all are fundamental to engaging care-experienced children and young people in physical activity (as well as being important for building positive relationships). Limited flexibility and freedom for care-experienced children and young people to choose the type of activity, where it takes place, and with whom, can negatively influence engagement (McLean and Penco, 2020; Quarmby, 2014; Quarmby et al, 2018b). We discuss a ‘trauma-informed’ approach to delivering physical activity for care-experienced children and young people in the next section.

The importance of social relationships

Across the research literature, the biggest enabler to care-experienced children and young people taking part in physical activity is trusting relationships with significant others, whether that be a family member, carer, professional, peer, or friend (Bruce et al, 2019; O'Donnell et al, 2019; Quarmby, 2014; Quarmby and Pickering, 2016; Quarmby et al, 2018a; Quarmby et al., 2018b; Quarmby et al, 2020). 

Care-experienced children and young people have highlighted the decisive impact of having people to champion their participation – nurturing their interest, providing practical support, and role modelling healthy behaviours (Bruce et al, 2019; Cox et al, 2018; Gilligan, 1999; Gilligan, 2000; Hollingworth, 2012; McLean and Penco, 2020; O'Donnell et al, 2019; Quarmby, 2014; Quarmby and Pickering, 2016; Quarmby et al, 2018b; Quarmby et al, 2018b; Quarmby et al, 2020; Whyte et al, 2024). 

However, care-experienced children and young people’s lives are often marked by instability, with changes in both living arrangements and the adults supporting them (social workers and carers), which may mean they lack the consistent support needed to engage in physical activity and sport (McLean and Penco, 2020; O'Donnell et al, 2019; Quarmby, 2014; Quarmby et al, 2020; Sandford et al, 2021; Whyte et al, 2024). Care-experienced children and young people in the UK may have someone such as an independent visitor, whose role specifically relates to helping the young person to develop new interests. However, as Sandford et al (2021) highlight, although a care-experienced young person may appear to have a wide network of support, the superficial nature of these relationships may mean they are an ineffective form of social capital.

As for all young people, friends and peer groups are also important influences on physical activity for care-experienced children and young people. For example, children and young people in an English residential care home explained that spending time with friends was their main reason for engaging in physical activity (Quarmby, 2014). In Sandford et al.’s (2021) study care-experienced children and young people said that friends were the most likely people to support their participation in physical activity – invitations from friends may be an enabler to take part in an activity. In other research, care-experienced children and young people overcame barriers to taking part in out-of-school physical activities when staff provided opportunities for them to take part with their peers, which may provide more enjoyment, inspiration, and motivation (Haaland and Tønnessen, 2022). Again, individual preferences will vary – some may also prefer to spend time with staff than their peers because of previous experiences of rejection (Haaland and Tønnessen, 2022).

As noted above, social isolation is a barrier to taking part in physical activity, and this remains true even in school PE – for instance children being picked last in competitive team activities (Quarmby et al, 2018a). Whether care-experienced or not, so called ‘non-dominant’ boys may be picked last, or added on to teams by teachers, reflecting an ‘explicit pedagogical method of symbolic exclusion’ (Jachyra, 2016, p.128; Quarmby et al, 2018a). This kind of exclusion, whether based on social factors or perceptions of children’s physical abilities, can lead to disengagement from physical activity both within and beyond school. Sport and physical activity can marginalise and exclude children and young people and reduce their feelings of self-worth (Berger et al, 2024). This may particularly be the case when competition is prioritised (Quarmby et al, 2020; Simpson, 2024) – although other care-experienced children and young people may be motivated by competition.

Physical activity can also be an opportunity for relationships to develop, and social opportunities have been cited as a benefit by care-experienced children and young people (Sandford et al, 2021). International research shows that outdoor physical activities can help care-experienced children and young people to develop trusting relationships with peers and adults, and develop feelings of acceptance and belonging (Haaland and Tønnessen, 2022; Whyte et al, 2024). In the Healthy Eating, Active Living programme in Australia, Cox et al, (2018) noted that off-site physical activities, away from residential care settings, built rapport between staff and young people which allowed young people to open up more and access emotional support. Care-experienced children and young people in the programme also developed the confidence to access other forms of physical activity in the community.

Trauma-informed practice

As has been highlighted, social interactions through physical activity are not guaranteed to be positive, and staff need to be supportive and mindful of individual needs and interests, to combat feelings of rejection and vulnerability (Whyte et al, 2024). As such the staff or individuals delivering/supporting physical activity can themselves be an important enabler or barrier to engagement. Evaluations of specific physical activity interventions for care-experienced children and young people suggest that a trauma-informed approach is necessary: ensuring safety and wellbeing, establishing routines and structures, developing and sustaining positive relationships that foster a sense of belonging, empowering youth voice (and choice), and promoting strengths and self-belief (Quarmby et al, 2020; see also Berger et al, 2024). 

Trauma-informed approaches are child-centred and recognise the importance of trust. A NICE (2021a, p.26) review of barriers and enablers to promoting wellbeing of care-experienced children and young people notes that 

 relationships based on trust help with engagement. Trust results from availability and reliability… working gradually and building rapport.”

 NICE guidelines (2021b, p.24) for promoting the health and wellbeing of care-experienced children and young people recommend that 

all practitioners working with looked-after children and young people are aware of the impact of trauma (including developmental trauma) and attachment difficulties and appropriate responses to these, to help them build positive relationships and communicate well.” 

Research has suggested a need for ongoing professional development for all those delivering organised physical activity – including in schools – to equip them to deliver trauma-informed practice (Berger et al, 2024; Quarmby et al, 2018a).

Respecting care-experienced children and young people’s freedom and choice is central to a trauma-informed approach. In general, all children are more likely to be active if they can choose the type of activity that matches their level of competence, interest and provides a sense of fun (Emm-Collison et al, 2022). Freedom and choice are also central to engaging care-experienced children and young people in physical activity, and this emphasises the need to consult with care-experienced children and young people and to listen to their voices – a key component of a trauma-informed approach. 

Care-experienced children and young people may also need to be empowered to make choices for themselves. For example, research in the context of outdoor physical activities in Ireland and in the U.S.A. found that information sessions before a physical activity programme and regular briefings with staff enabled care-experienced children and young people to feel prepared and informed to make their own choices about taking part, especially because some were trying activities for the first time (Conlon et al, 2018; Schelbe et al, 2018). Informing the care-experienced children and young people of plans for the physical activity, the type of activities available, and giving them the choice about what to engage with and how (for example 1-to-1 or in a group) enhanced the enjoyment, fun and novelty of physical activity for care-experienced children and young people (Conlon et al, 2018; Schelbe et al, 2018). Additionally, as part of outdoor recreational activities in Norway, Haaland and Tønnessen (2022) found that the variety of activities on offer increased care-experienced children and young people’s motivation. However, it should be noted that in some instances too much choice could be overwhelming for some of those impacted by trauma.

Beyond providing choice, Rose and Sound (2020) in a review of physical activity interventions for underprivileged young people in general, suggest that a key factor is ‘supporting the development of young people’s autonomy’. Supporting autonomy in practice may involve staff acknowledging children and young people’s negative emotions, providing choice, providing opportunities for children and young people to follow their own initiative and take part at their own pace, whilst being warm and caring (Jeno and Diseth, 2014). Supporting the development of young people’s autonomy is suggested by Rose and Sound (2020) to increase their motivation to take part in physical activity, as well as directly contributing to improvements in young people’s mental health.

The role of carers

All children and young people’s attitudes and relationship to physical activity are shaped by their significant relationships, their communities and society at large. NICE’s (2021a) review found that 

 Looked after children get their information about healthy living from a variety of sources (e.g. internet, social media) but the key influence was through the primary caregiver relationship”

and suggested that

 

first placement was key to pro-actively tackle healthy living e.g. … encouraging exercise”. 

Repeated disruptions to relationships may prevent care-experienced children from taking on carers’ values and practices around physical activity (Sandford et al, 2021). But there are also a wide range of attitudes to physical activity amongst carers. Carers may lack personal experience of regular engagement in sport or physical activity themselves, and/or they may not see the value in such activities (Sandford et al, 2021). Surveys suggest that a majority of parents may not be aware of NHS guidelines recommending that children get 60 minutes of exercise every day (Ward, 2023). McKearney and Bennett’s (2020) study of two English counties suggested that foster carers and prospective adopters may tend to be more overweight and obese than the general population; and levels of obesity in special guardians are significantly higher, with half of this group found to be obese and more than a quarter ‘morbidly obese’. Special guardians were also most likely to have medical problems – 24 per cent were found to have three or more serious health issues. It is worth noting that many special guardians are grandparents and so are likely to be older.

Care-experienced children and young people report that some carers are unable or unwilling to support their engagement with physical activity – for example by taking them to a sports club (Sandford et al, 2021). The financial barriers faced by carers may prevent them supporting children and young people to take part in physical activity. They may also be struggling in other ways and may not be able to prioritise physical activity (Green et al, 2021). Carers may have specific objections to young people participating in certain activities; some carers may support care-experienced children and young people to take part in physical activity in a general sense but may not understand their specific needs or interests in detail (Sandford et al, 2021). 

Where carers are supportive, they can be a powerful enabler for care-experienced children and young people to take part in physical activity. Carers (and other ‘official’ adults in young people’s lives) can connect children and young people with relevant information and contacts. They can encourage, motivate, facilitate, serve as role models, and even participate directly in physical activity with young people. To do this effectively, carers may need information about available activities, training and support (Sandford et al, 2021; Green et al, 2021).

General barriers and facilitators to taking part

Unsurprisingly, access to relevant information about properly resourced opportunities is an enabler to taking part in physical activities. Care-experienced young people note that a lack of opportunities locally is a barrier (Sandford et al, 2021). The location of activities can also be restrictive. Transport options may be a fundamental barrier, especially in rural areas (Schelbe et al., 2018; Sandford et al., 2020). Care-experienced children and young people may not have anyone to take them to and from sports clubs or activities (Sandford et al, 2021).

Finances can also prevent care-experienced children and young people from taking part when they or their carers cannot meet the costs of transport, equipment, or fees (Sandford et al., 2020: Whyte et al, 2024). Some council sports centres provide free access to care-experienced children and young people (Ward, 2023). The need for kit or equipment can be a barrier independent of cost – for example if a child is moving regularly and doesn’t have access to appropriate/relevant kit (Quarmby et al, 2018a).

What - the type and format of activity

The format of physical activity and the context in which it takes place are of course key factors – including the type of physical activity, when it takes place and the reasons for engagement, where it takes place, who supports or delivers the physical activity, and how it is delivered (Whyte et al, 2024). The principles of trauma-informed delivery, discussed above, apply to the structure and organising of physical activity as well as the way in which it is delivered – 

Participating in physical activity and sport is not, on its own, likely to achieve positive outcomes for trauma-impacted young people. How these programs are structured and delivered and by whom are all important factors in how physical activity programs may contribute to positive benefits for trauma-impacted young people” 

(Berger et al, 2024, p.2593). This emphasises the importance of creating a safe space for care-experienced children and young people’s participation in physical activity (Whyte et al, 2024; Schelbe et al, 2018).

Although the type of activity on offer is important, this may have more to do with children and young people’s interests rather than anything intrinsic to the activities themselves. The international evidence on physical activity interventions with care-experienced children and young people is limited (yoga programmes are among the most evaluated) – and there is no clear evidence to suggest that certain types of physical activity are more effective than others in creating positive outcomes for this group (Berger et al, 2024). Trauma-informed delivery of activities including yoga, aerobic or resistance training, surfing, martial arts, football, basketball as well as outdoor recreation activities have all been found to be effective. There is some evidence that multi-sport interventions are particularly effective, which may reflect the importance of giving choice and supporting autonomy, as highlighted above (Berger et al, 2024). Care-experienced children and young people, in Sandford et al.’s (2021) study, noted that the relevance (or not) of the specific activities offered was a key factor. Ensuring activities reflect the local context, and the needs and interests of children and young people – that they resonate and are relevant – may be more important than a specific form of sport or physical activity (Berger et al, 2024).

As we have noted, some care-experienced children and young people may benefit from a structured context for physical activity (including school-based sport), and others may prefer self-directed or unstructured physical activity (walking and cycling, roller-skating, playing in parks) (Sandford et al., 2023; Whyte et al, 2024). The importance of freedom and choice in physical activity have been highlighted, as well as the importance of enjoyment, and for some the chance to engage with others, including friends and peers. As already discussed, a sense of competition in activities might lead to negative effects for some (Berger et al., 2024; Simpson, 2024). Physical activity is also sometimes embedded in wider organised youth activity (e.g. St John’s Ambulance, Air Cadets or Scouts) which may help to engage some children and young people (Sandford et al., 2021). 

Besides the trauma-informed approach, there are psychological theories which anybody designing physical activity programmes for care-experienced children and young people might consider. ‘Self determination theory’ suggests that children and young people’s intrinsic motivation to take part can be affected by supporting their autonomy, building from social connections, and allowing them to develop feelings of competence in activities (Simpson, 2024). ‘Positive youth development theory’ suggests a ‘strength-based approach’ – building on young people’s positive capabilities – and emphasises the importance of community support.

Where – the site of physical activity

The site of physical activity has been noted as a key enabler or barrier for care-experienced children and young people. Homes, schools, leisure centres, gyms, other local facilities, parks and gardens can all facilitate physical activity or present challenges. Fitzgerald et al.’s (2014) physical fitness intervention with care-experienced young people recognised the common difficulty of engaging this group with regular activities. Fitness therapists travelled to participants’ houses for each session and this was central to securing a very high attendance rate for the programme (Fitzgerald et al., 2014). The gym has also been recognised as a key place for (older) care-experienced young people – providing young people with free membership through local authority is seen as an ‘easy win’ (Sandford et al., 2021). These schemes must however be managed sensitively as some care-experienced young people have reported on the stigma of gym cards that are different to others’ free membership cards. Data on the access to and uptake of free memberships is currently extremely limited.

PE and school sport has been mentioned already and provides the opportunity of regular, structured and supported physical activity. However, as Sandford et al (2021) highlight, the role of schools in providing physical activity needs further attention – with a disconnect between expectations and the reality of care-experienced children and young people’s participation and engagement. Physical activity in school can be particularly challenging for care-experienced children and young people if they are having multiple negative experiences within school (Whyte et al, 2024; O'Donnell et al, 2019). There may also be fundamental system-level barriers – for example, care-experienced children and young people report being unable to attend after-school clubs because of needing to get a taxi at a set time (Sandford et al, 2021). Additional support may be needed for schools and teachers to deliver for care-experienced children and young people in line with the trauma-informed approaches discussed above.

In their research, Sandford et al. (2021) highlight the ‘missing spaces’ not mentioned as sites of physical activity for care-experienced children and young people. These included extra-curricular school sport, sports clubs and wild spaces. As already noted, care-experienced children and young people may be excluded from these sites due to cost, travel, logistics and accessibility, as well as their own concerns about engaging; repeated placement moves also limit the possibility for sustained engagement with clubs (Sandford et al, 2021).

The care system

The structures and processes within the care system itself directly affect children and young people’s capacity to take part in physical activity. Care-experienced children and young people report significant challenges in accessing sport/physical activity and often point to the narrow range of opportunities they perceive to be open to them. Moreover, they report challenges in maintaining their participation over time and the limited control they have over this. As discussed above, such challenges are often influenced by the ‘official’, external structures that shape their lived experiences, for example: processes of monitoring, safeguarding and consent; issues of logistics, equipment and funding; requirements for official meetings and documentation; and the transient nature of care contexts (e.g. placement moves, transitions in and out of care and the frequent changes in assigned key workers) (Sandford et al, 2021).

The instability produced by the care system has already been highlighted, with changes in living arrangements and the adults supporting them impacting care-experienced children and young people’s capacity to engage in physical activity (McLean and Penco, 2020; O'Donnell et al, 2019; Quarmby, 2014; Quarmby et al, 2020; Sandford et al, 2021; Whyte et al, 2024). In Sandford et al.’s (2021) study, care-experienced children and young people reported having so many changes of social worker that information was not being passed on and they did not know what was available to them; some were also unable to build any kind of meaningful connection with social workers. As already noted, changes to carers and ‘official’ adults – with different principles and values around physical activity – can disorientate children and young people and leave them unable to relate to adults’ values related to physical activity (Quarmby et al, 2018a). 

Changes in placements and schools can result in children and young people missing out on school-based sporting activities; out-of-school activities may also be disrupted (Quarmby, 2021; Sandford et al, 2021). Care-experienced children and young people’s mental health challenges are most pronounced in times of transition, affecting their motivation and engagement (NICE, 2021a). Engagement in physical activity can decrease when care-experienced young people transition out of care – which can be a time of disruption and unpredictability and can be experienced by care leavers as a withdrawal of support (Gilligan, 1999; Hollingworth, 2012; McLean and Penco, 2020; Quarmby, 2014; Quarmby et al, 2020; Sandford et al, 2021; Whyte et al, 2024).

Navigating the system

Care-experienced children and young people may need to ask various people for permission to do certain activities, and this may require agreement between various adults (social workers, team managers, service managers, etc.) (Sandford et al., 2021). Structural and organisational policies in care settings, such as set meal times, and needing to negotiate time for activities with staff, affect opportunities for engagement (Quarmby, 2021). A tendency to be ‘risk averse’ in safeguarding processes can also block children and young people from opportunities to participate in physical activity (Sandford et al., 2021). Care-experienced children and young people may feel embarrassed or stigmatised when accompanied to physical activity by social workers or foster carers; some young people do not want to be ‘exposed’ as being care-experienced in organised sport and may simply avoid these contexts (Sandford et al., 2021). Some of these are interpersonal issues as well as structural ones – which emphasises how factors at different levels interact with each other.

Residential children’s homes

Sandford et al. (2021) noted the low proportion of young people they surveyed identifying residential children’s homes as a site to engage in physical activity. In residential children’s homes some challenges are amplified. Children and young people in these settings highlighted recreational facilities they were unable to use because of staffing ratios – or individuals only able to go out with certain members of staff (Quarmby et al, 2020). Facilities may also be damaged or broken (Quarmby et al, 2020). Being able to access external physical activity opportunities may depend on which staff members are on a shift, or able to drive a young person, and inconsistent staff rotas and staff sickness undermine the possibility for children and young people’s consistent engagement in physical activity (Green et al, 2022; Quarmby et al, 2020; Quarmby et al, 2018a). 

A high turnover of staff may limit young people’s ability to form connections, and they may be reluctant to ask for help or support from carers they do not know well (Fitzgerald et al, 2014; Quarmby et al, 2020). There may simply be insufficient staff to support children and young people to take part in physical activity, with staff feeling time-poor and overwhelmed (Green et al, 2022). Staff may also simply fail to encourage young people’s participation in physical activity (Sandford et al, 2021). Nonetheless, many staff in residential homes recognise the impact of trauma and the care environment on children and young people and their engagement in physical activity; they also recognise the benefits of physical activity for young people and the opportunities physical activity offers to build relationships with young people (McLean and Penco, 2020). Shared activities with staff may represent an effective strategy for engaging some young people (McLean and Penco, 2020).

Research into the Healthy Eating, Active Living programme in residential children’s homes in Australia noted a number of enablers to the success of the programme. These included: the engagement of leadership around physical activity; sustained attention given to physical activity (as a standing agenda item in meetings); the presence of physical activity champions; adequate resourcing; time given for training and reflective practice, and accountability for training; a whole-team approach to physical activity; the integration of physical activity into organisational policies; and consideration of physical activity in hiring staff (Green et al, 2022). In Norway, in contrast to the UK, outdoor recreational activities are embedded as part of care-experienced children and young people’s residential care (Whyte et al, 2024).

A lack of coordination

Across the care system, physical activity and sport is often not prioritised for care-experienced children and young people. Sandford et al. (2021) highlight the tendency for young people’s experiences to be compartmentalised within the care system – for example: providing financial support, finding housing, removing them from harm, educating them. The piecemeal nature of these structures can mean that children and young people’s interests, engagements and connections can fall by the wayside. There is an influence of age/stage as well, with – for example – different priorities for young people transitioning out of care. Sandford et al. (2021) suggest that a more holistic understanding of care-experienced children and young people’s lives is necessary, as is a joined up, multi-agency approach – with different stakeholders working in partnership to facilitate children and young people’s access to physical activity. 

Clear policies and specific guidance may help with this – the current ‘loose’ policy context leaves scope for omissions and oversights in practice. It remains unclear as to whose responsibility it is to facilitate and support care-experienced children and young people’s participation in physical activity or sport (Sandford et al, 2021). Older policy documents suggest that it was seen as a foster carer’s responsibility; references that exist in policy documents are often focussed on leisure activities as opposed to sport; and the vast majority (92 per cent) of staff surveyed by Sandford et al. (2021) felt that it was the responsibility of schools to promote physical activity. 

Alongside more joined-up working, the importance of physical activity and sport needs to be better promoted to those who work with/for care-experienced children and young people (Sandford et al, 2021). Systems and processes must support this – Government guidance already notes that exercise/physical activity should be a part of health assessments (DfE, 2015); however this may not be being prioritised relative to other health considerations. Ward (2023) notes that knowledge about children’s preferences and capabilities relevant to physical activity should be shared when they enter care or change placement; Ward (2023) highlights the concept of ‘Essential Lifestyle Planning’ as a useful model to provide new carers with sufficient information and ensure that children’s individual needs can be identified and met.

Resource constraints (i.e. funding) is an obvious system-level barrier (NICE, 2021a); the well-publicised constraints on council funding (including Section 114 notices in some areas) have sometimes been accompanied by the reduction or elimination of targeted initiatives (including access to gyms or leisure centres). Geographical variation is also significant – with obvious differences between some rural and urban localities in access to facilities and open spaces. Geography and funding may also interact – with funding distributed differently in different local authorities (Sandford et al, 2021).

Barriers and enablers for specific groups of children and young people

Other issues affecting engagement with physical activity may be specific to individual groups. Girls and young women face additional barriers to participating in physical activity including concerns about harassment and being observed (LGA, 2024). Some girls and young women may be put off by a competitive environment or simply be uneasy participating with boys and young men. These issues can intersect with others; another barrier to participation is a lack of understanding or engagement around cultural norms and faith sensitivities, e.g. around dress or the types of activities on offer (LGA, 2024). 

Cultural norms and expectations around what are ‘appropriate’ behaviour, both among children and young people and/or among supporting adults, can affect engagement with physical activity. Where such expectations are particularly oppressive (as they may be for some girls and young women, for example), physical activity can in fact be an ‘escape’, resulting in more sustained participation. (Quarmby et al., 2020).

Unaccompanied asylum-seeking children and young people

Unaccompanied asylum-seeking children and young people are placed in the care system when they arrive in the UK. These children and young people have distinct needs “as a result of previous traumatic journeys on the way to the UK, and disorientating journey through multiple systems within the UK.” ( NICE, 2021a). “Mental health is often linked to immigration status”, and there can be a significant impact of the long wait for a secure migration status; the backlog for children is greater and may represent a significant proportion of a child’s life (NICE, 2021a; Camps et al., 2023)

The combination of hope and dread has been described as a ‘half-life’, with some children and young people struggling to find an anchor in their lives and feeling trapped and reluctant to settle into daily routines; this context can lead to self-neglect (Camps et al., 2023). Additional challenges may include language barriers, a mistrust of professionals, loneliness and loss of identity (NICE, 2021a). 

Physical activity can help to build a meaningful daily life for an unaccompanied asylum-seeking child or young person waiting for a final decision on their migration status, as demonstrated by (Camps et al.,2023) review in Scotland that noted that access to gyms was seen as particularly important, forming part of young people’s routines while living in temporary accommodation. It was suggested that the gym allowed young people to feel good about themselves, feel more independent, and was a space where they did not stand out and could socialise. Football and cricket were also identified as popular activities – although asylum-seeking children and young people sometimes struggled to take part due to challenges around funding for equipment or transportation (Camps et al., 2023). Young people living with host and foster families had a better chance to participate in physical activity as they received additional support. Some asylum-seeking children and young people reported concerns about taking public transport in the evening, and other concerns due to experiences of hostility and racism (Camps et al., 2023).

It is worth noting that some boys and girls may prefer to socialise separately in line with cultural traditions. Portrayals of the type of support male (typically seen as being vulnerable to social exclusion) and female (typically seen as in need of psychological assistance and therapeutic support), asylum seeking children and young people require may affect the opportunities for physical activity (if any) that are made available. (Camps et al., 2023)

Care-experienced children and young people with disabilities

As noted above, more than a quarter of care leavers reported having a disability (Baker and Briheim-Crookall, 2024); and each care-experienced child and young person's experiences will be different. There is limited research on supporting care-experienced children and young people with disabilities to participate in physical activity. However, research with children and young people with disabilities in the general population highlights some of the support that can increase physical activity – children and young people need access to programmes and services that: (i) provide a variety of activities with the choice to opt-out; (ii) are graded for inclusion – offering activities at varying levels of difficulty and support; (iii) are without time pressures; (iv) provide predictability and opportunities to establish routines; and (v) enable access to nature and the outdoors (Smith et al., 2022). Adaptive equipment and assisted devices can also increase access to physical activity. 

In contrast, the availability of equipment and the time required to set it up, long travel times to activities, inadequate support in schools, the competing demands across families, and the lack of support from providers are all barriers to engagement in physical activity for children and young people with disabilities. Some delivery organisations also have a lack of condition-specific knowledge to appropriately support participation (Smith et al., 2022). Social care professionals, schools, physical activity and sports organisations, and carers need to be aware of discrimination against those with disabilities, and to ensure that participation in physical activity is a matter of individual choice and not determined by disablism, health inequalities, or other systemic barriers.

This review has drawn together literature on the barriers and enablers for care-experienced children and young people taking part in physical activity. Barriers and enablers have been organised into three levels: (i) the individual care-experienced child or young person; (ii) social or interpersonal factors (reflecting children and young people’s interactions with others); and (iii) wider environmental or system-level factors. At each level, there are factors that may be decisive, for example: children and young people’s physical and mental health means that they may need additional support to take part in physical activity; trusting relationships with significant others can be crucial in supporting physical activity, providing both emotional and practical support to taking part; a lack of opportunities locally, or restrictions on travel may prevent children and young people from accessing opportunities for physical activity. 

All children, whether care experienced or not, need support to develop full, physically active lives. For care-experienced children and young people, support needs to be aligned to overcome barriers at the three levels discussed: 

• Are activities offered to children and young people which are relevant to their needs and interests, and which resonate with them and their identity – including their self-perceptions around sport and physical activity?
• Are children and young people’s voices and individual preferences being listened to, and are they being given choice?
• Does physical activity build on their trusted social connections, and is organised physical activity delivered in a trauma-informed way?
• Are all professionals being given ongoing support and training to deliver a trauma-informed approach?
• Are carers being given specific information, support and training – reflecting their important role in supporting physical activity?
• Are opportunities being funded in accessible locations?
• Is the care system itself prioritising physical activity for children and young people – in its leadership, policies, and processes?
• Whose responsibility is it to support care-experienced children and young people to access physical activity?
• Are the specific needs of individual groups of children being considered?

This review has been published alongside a new guidance document – Guidance on improving opportunities for physical activity for care-experienced children and young people (LGA, 2025) – which details how some of these questions can be answered.

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