A functional-condition-based expert framework for safe participation in school physical education among children with health conditions

Abstract Regular physical activity is essential for healthy growth, cardiometabolic health, musculoskeletal development and psychosocial well-being in children and adolescents. However, children recovering from illness or living with chronic, fluctuating or disabling health conditions are often restricted from school physical education primarily according to diagnostic labels rather than functional capacity. This Perspective presents a functional-condition-based expert framework designed to help general practitioners determine safe, proportionate and inclusive participation in school physical education. The framework translates evidence from international physical activity guidance, pediatric exercise physiology, sports medicine consensus recommendations and multidisciplinary expert input into a practical decision model. It integrates clinical stability, symptom burden, physiological reserve, treatment-related considerations, contextual safety risk and staged return-to-activity. Children are assigned to Health Functional Groups – Basic, Preparatory or Special – linked to permissible intensity zones and school-based adaptations. By shifting decision-making from diagnosis-based restriction to function-based participation, the framework provides a translational bridge between clinical assessment and educational practice.