1 Background: It is argued that regular engagement in physical activity (PA) has the potential 2 to mitigate the negative health and educational outcomes that disadvantaged children living in 3 care frequently face. However, little is currently known about children in care's participation 4 in PA. This scoping review primarily aimed to identify barriers and facilitators to PA 5 participation for children in care. Methods: The main phases of the scoping review were: (1) 6 identifying relevant

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... dies; (2) selecting studies based on pre-defined inclusion criteria; (3) 7 charting the data; and (4) collating, summarising and reporting the results. All relevant studies 8 were included in the review regardless of methodological quality and design. Results: The 9 seven articles that met the inclusion criteria were published between 1998 and 2013 and 10 conducted in the USA (3), England (2) and Norway (2). A social ecological model was 11 incorporated to map results against levels of influence. Conclusions: Various factors influence 12 PA engagement for children in care. Barriers include low self-efficacy, instability of their social 13 environment, which impacts on schooling and maintaining friendship groups and, specific 14 institutional practices and policies that may prevent access to PA. Before fully considering 15 policy implications, further research with children in care is warranted in this area. Very little is currently known about children in care's participation in physical activity (PA), 2 or the barriers and facilitators to their engagement. Understanding of PA access and the value 3 children in care place on PA is important since they are among the most vulnerable and 4 disadvantaged members of society. 1 Often exposed to violence, poverty and parental substance 5 abuse, 2,3 children in care typically suffer poor physical and mental health, have difficulties with 6 their social and emotional wellbeing, and lack stable relationships resulting in problems with 7 attachment and lack of resilience. 4 Those subjected to severe neglect, violence or abuse tend to 8 find interacting with wider networks and communities outside the care system particularly 9 difficult. 2,3 It is thought that taking part in regular, structured PA offers children in care an 10 opportunity to reintegrate into mainstream society and develop new social networks beyond 11 the care system. 5 12 13 In England and the United States of America (USA), the number of children in care is 14 increasing, with the majority cared for in a foster placement, while some are placed in 15 residential children's homes (RCH). 6,7 A significant gap exists between the quality of lives for 16 children in care compared to their peers not in care. In fact, many children in care do not achieve 17 the same standards in education as those in the general community, with 68% of children in 18 care in England having a Special Educational Need (SEN). 8 These figures pose significant 19 detriment on the future life and career prospects for these young people. However, Public 20 Health England 9 have highlighted that a positive relationship exists between levels of PA 21 engagement and academic attainment. Research suggests that aerobically fit children achieve 22 greater academic success 10 and have better brain function and memory task performance than 23 less fit children. 11 PA therefore can be seen to offer potential to begin to reduce the disparity 24 in educational attainment between those in care and their peers. It is also believed that engagement in regularly scheduled, extracurricular PA provides a sense of structure to the lives 1 of children in care that is otherwise missing due to substantial, continual changes in care 2 placements. 12 3 4 Beyond educational attainment, PA may offer further developmental potential for these 5 disadvantaged young people. For instance, with children in care experiencing a "higher 6 prevalence of both psychosocial adversity and psychiatric disorder than the most 7 socioeconomically disadvantaged children", 13(p323) the link between PA and mental health is 8 especially important. Furthermore, engagement with competitive PA (e.g. sport) enables 9 children in care to develop resilience; "a capacity to do well despite adverse experience". 14(p37) 10 Hence, regular engagement in PA could help foster 'normal' development, strengthen 11 assertiveness, build self-esteem and confidence, and help develop skills required to deal with 12 future life experiences. 5,14 13 14 PA may provide opportunities to enhance wellbeing and overall quality of life for those 15 children in care who experience poorer educational and health outcomes compared to their 16 peers. In a recent review of literature, it was identified that overweight and obesity prevalence 17 in children in care is greater than in the general population, 15 increasing their risk of developing 18 serious health conditions in later life, such as diabetes and cardiovascular disease. 16 Regular 19 PA participation could therefore help reduce the prevalence of overweight or obese young 20 people, and thus reduce future health complications for children in care. 21 22 Finally, as alluded to above, the label 'in care', is often associated with a range of negative 23 outcomes (albeit when compared to normative measures). This label may ultimately shape 24 children in care's own expectations and aspirations. There is also a risk that those facing 25 Physical activity and children in care 5 adversity and labelled 'in care' may develop a stigmatised and, ultimately, all-embracing 1 'master' identity such as 'child in care'. 17 However, engagement in PA may allow children in 2 care to generate a positive sense of identity, since participation in PA may enable them to 3 diversify their repertoire of socially valued roles, re-shaping their identity. 17 5 Despite the asserted benefits of PA for children in care, evidence from the USA suggests that 6 when compared to young people living in two parent, lone parent and step family households, 7 those in foster care and RCHs were less likely to achieve the recommended levels of PA. 18 One 8 reading of this is that children in care appear to engage in less PA than those in some of the 9 more diverse family structures. Thus, there is a need to better understand why children in care 10 might be less likely to achieve recommended levels of PA since increasing PA may mitigate 11 the negative health and educational outcomes discussed earlier. Ultimately, since there is a lack 12 of knowledge around how active children in care are or how they engage with PA, it is first 13 important to determine what the existing literature details in order to be able to focus future 14 research directions and help shape policy. Due to the broad, multidisciplinary nature of PA 15 research in general populations, coupled with a lack of children in care specific research in PA, 16 the primary aim of this paper was therefore to conduct a scoping review of the international 17 literature to gain insight into the barriers and facilitators to PA engagement for children in care. 18 To date, no study has attempted this. 19 20 As a result of the overarching aim of this study and the limited research in PA that engages 21 with children in care, two subsequent sub-aims included: 22 17 18 Identifying relevant studies 19 A comprehensive search was performed using six academic journal databases (Sports Discus, 20 Physical Education Index: ProQuest, Social Care Online, PsycINFO, MEDLINE, ERIC). This 21 gave access to a range of health, sport and education journals. These databases were searched 22 for articles published between 1989 (when the term children in care was first muted in the 1989 23 Children Act in England) and 2014. The term 'physical activity' is used here to encapsulate 24 sport, curriculum PE, schools' extra-curricular provision and physical activities undertaken 25 Physical activity and children in care 7 away from school. A list of keywords and alternative keywords were created, combined using 1