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Preschool-aged children (three to five years old) born preterm participate in less physical activity (PA) than term-born children. Circus activities (a type of recreational PA) are a potential avenue to increase PA rates, but further insight into how to tailor these to address the participation gap is needed. This study investigated barriers and facilitators informing participation in recreational PA for preschool-aged children born extremely preterm and explored strategies to enhance participation in circus activities. Sequential mixed-methods study utilizing surveys ( n  = 217), interviews ( n  = 43), and a focus group ( n  = 6) with key stakeholder groups (parents, coaches, and clinicians). Qualitative data (Framework Method) and quantitative data (descriptive statistics) were mixed during preliminary and final analyses. Five themes were developed from the mixed data: the crucial role of the coach and the need for specific training, the therapeutic role of PA and promoting outcomes beyond the physical, the impact of communication and class planning, consideration of convenience and cost, and finally, the role of clinicians. Barriers, facilitators, and strategies were identified which may be used to modify or co-design circus-based PA interventions to enhance participation and improve rates of PA for preschool-aged children born extremely preterm.IMPLICATIONS FOR REHABILITATIONFamilies consider recreational physical activities to be part of the therapeutic agenda for their preschool-aged children born extremely preterm.Key stakeholders feel that recreational physical activity should target outcomes beyond the physical.Coach attributes and capability impact participation of children born preterm and their families, and may be enhanced with specific training.Clinicians should be engaged in design of recreational physical activities for children born preterm. Families consider recreational physical activities to be part of the therapeutic agenda for their preschool-aged children born extremely preterm. Key stakeholders feel that recreational physical activity should target outcomes beyond the physical. Coach attributes and capability impact participation of children born preterm and their families, and may be enhanced with specific training. Clinicians should be engaged in design of recreational physical activities for children born preterm.

disability and rehabilitation

“We are a unique breed”: strategies to enhance physical activity participation for preschool-aged children born extremely preterm, a mixed-methods study