This ProCare Therapy report highlights top states where all kids—regardless of abilities—have access to physical activity and inclusive play.
Every child deserves the chance to grow up healthy, strong, and active. Yet in the United States, four out of five children (81.1%) currently fail to meet the recommended guidelines for daily physical activity—and for children with special health care needs, that figure climbs even higher to 84.4%.
For kids, regular physical activity not only helps prevent chronic diseases like obesity and diabetes, but it also supports better concentration, reduced anxiety, and improved social skills. Despite these known benefits, research shows that many children across the United States fail to meet the recommended levels of physical activity.
At ProCare Therapy, we believe that every child deserves the chance to thrive, regardless of their background or abilities. In some states, the sports participation rate for children with special health care needs is over 20 percentage points lower than the average.
Physical activity is not just about the fitness benefits; it plays an important role in fostering confidence, building relationships, and ensuring physical, mental, and emotional well-being. This report, commissioned by ProCare Therapy, seeks to spotlight the states that excel in promoting physical activity among children, while emphasizing the importance of inclusivity in sports and recreational opportunities.
By analyzing various indicators such as sports participation rates, access to recreation centers, adaptive sports programs, children’s physical activity levels, and more, this report highlights which states best ensure that all kids—including those with disabilities—have access to meaningful opportunities.
Key Findings
The results of the ProCare State of Play Index reveal significant variations among states, with top-ranking states demonstrating a strong commitment to both physical activity and inclusivity.
The top three states are New Hampshire, Connecticut, and Maine, each excelling in different aspects of the index. Here is an in-depth look at their performance:
- New Hampshire
With a total score of 78.12 out of 100 total possible points, New Hampshire sets the gold standard for children’s physical activity. The state’s achievements include:
- Sports Participation: The seventh highest in the nation, New Hampshire boasts high rates of after-school sports participation among children (60.7%), reflecting a community culture that prioritizes structured and enjoyable physical activity for children.
- Adapted Sports Programs: The state excels in inclusivity, with a significant percentage of schools that sponsor competitive basketball programs also sponsoring unified and adapted basketball programs. In New Hampshire, 61.6% of these schools offer unified or adapted girls’ basketball programs and 60.9% offer boys’ basketball programs, the second and third-highest percentage in the nation, respectively.
- Access to Recreation Centers: Recreation centers across the state provide children with safe, accessible spaces to stay active. In New Hampshire, 50% of children have a recreation center in their neighborhood, reinforcing New Hampshire’s commitment to inclusive youth fitness.
2. Connecticut
Connecticut ranks second with a total score of 75.51, standing out in several key areas:
- Recreation Center Access: Connecticut offers the seventh-highest access to recreation centers in the nation (58.5%), ensuring that children have safe and engaging spaces for physical activity.
- Inclusive Sports Programs: The state has the fourth-highest presence of unified and adapted high school basketball programs for boys (59.3%) and girls (59.3%), highlighting its dedication to equity by supporting high school students with disabilities to participate competitively in basketball programs.
- Sports Participation: Opportunities for children to participate in after-school sports teams or lessons are widely available in the state, with 56.8% of children developing teamwork and physical skills in a fun and supportive setting.
3. Maine
Maine’s total score of 74.27 reflects its strong commitment to children’s physical activity and inclusivity. Key achievements include:
- Adapted High School Sports: Maine excels in providing unified and adapted boys’ (62.4%) and girls’ (59.6%) basketball programs, the second and third highest in the nation, respectively.
- Physical Activity: A significant percentage of children (24.5%) meet the CDC’s recommended activity levels for kids (60 minutes daily). This reflects the state’s effective community initiatives and comprehensive school PE programs.
- Sports Participation: The tenth-highest sports participation rate among children (58.9%), Maine’s active culture encourages widespread involvement in healthy after-school activities, supporting children’s physical and social development.
The Lowest Ranking States
While some states excelled, others ranked significantly lower, highlighting areas where improvements are critically needed. The three lowest-ranking states in the index are North Carolina (50), Louisiana (49), and Mississippi (48).
Neither boys’ or girls’ unified or adapted basketball programs are offered in these states, meaning children with disabilities face significant barriers to participation in team-based, competitive sports.
These states also scored poorly across multiple indicators, landing in the bottom ten for both after-school sports participation and access to recreation centers, signaling that fewer children have opportunities to engage in structured physical activities.
For any state, addressing these challenges is no walk in the park; however, ensuring children have opportunities to engage in physical activity is essential. With targeted investments in recreational infrastructure, school-based programs, and community engagement initiatives, we can create environments where all children, regardless of ability or background, can stay active and healthy.
The State of Play Index: The Full Ranking
Explore the comprehensive ranking of all 50 states based on their total scores in the ProCare State of Play Index:
| Rank | State | Score |
| 1 | New Hampshire | 78.12 |
| 2 | Connecticut | 75.51 |
| 3 | Maine | 74.27 |
| 4 | Rhode Island | 71.08 |
| 5 | Vermont | 60.33 |
| 6 | Massachusetts | 60.04 |
| 7 | Illinois | 50.68 |
| 8 | Wyoming | 48.46 |
| 9 | Minnesota | 47.43 |
| 10 | New York | 47.26 |
| 11 | New Jersey | 45.15 |
| 12 | Iowa | 44.72 |
| 13 | North Dakota | 43.19 |
| 14 | Kansas | 39.37 |
| 15 | Colorado | 38.74 |
| 16 | Michigan | 37.95 |
| 17 | Wisconsin | 37.48 |
| 18 | Nebraska | 37.02 |
| 19 | Montana | 36.84 |
| 20 | Utah | 36.57 |
| 21 | South Dakota | 36.55 |
| 22 | Ohio | 36.27 |
| 23 | Alaska | 35.56 |
| 24 | Arkansas | 35.08 |
| 25 | California | 33.68 |
| 26 | Missouri | 33.57 |
| 27 | Hawaii | 32.37 |
| 28 | Maryland | 32.17 |
| 29 | Pennsylvania | 31.25 |
| 30 | Idaho | 29.22 |
| 31 | Indiana | 28.87 |
| 32 | Delaware | 28.50 |
| 33 | Oregon | 27.19 |
| 34 | Alabama | 25.42 |
| 35 | Washington | 25.17 |
| 36 | Virginia | 24.24 |
| 37 | Tennessee | 22.90 |
| 38 | West Virginia | 22.70 |
| 39 | Georgia | 22.12 |
| 40 | Texas | 20.16 |
| 41 | South Carolina | 18.82 |
| 42 | Florida | 18.62 |
| 43 | Kentucky | 18.50 |
| 44 | Arizona | 18.44 |
| 45 | Oklahoma | 17.51 |
| 46 | New Mexico | 16.18 |
| 47 | Nevada | 14.54 |
| 48 | Mississippi | 13.38 |
| 49 | Louisiana | 13.10 |
| 50 | North Carolina | 12.42 |
The Importance of Inclusive & Accessible Physical Activity
Sports and physical activity are about more than just exercise—they foster connection, confidence, and a sense of belonging. For children with disabilities, having the opportunity to participate alongside their peers is essential, not optional.
One of the most compelling findings of this report is the critical role of inclusivity in states’ rankings. States that prioritize unified and adapted sports programs consistently outperform others, demonstrating the broader benefits of inclusive opportunities. When schools and communities prioritize inclusive and accessible physical activities, they create environments where every child can thrive, regardless of ability.
At ProCare Therapy, we are committed to advocating for programs that support youth fitness and inclusivity. If you’re interested in a role where you can help support children’s health inside the school setting and beyond, we invite you to explore our opportunities today, including openings for adapted PE teachers, school nurses, school-based physical therapists, orientation and mobility specialists, and more.
Together, we can ensure that every child has the opportunity to move, play, and grow in a supportive and inclusive environment.
Methodology
The State of Play Index aims to evaluate and rank U.S. states based on key indicators that assess access to physical activity for all children. It uses reputable, publicly available datasets from sources such as the CDC. Each indicator is scored and weighted equally (20%). The final score is calculated by multiplying each indicator’s normalized score by its weight, summing the results to rank states from best to worst. To evaluate the best states for active children, the ProCare Physical Activity Index analyzed five key indicators:
- After-School Sports Participation: This metric reflects the percentage of children involved in after-school sports or lessons. Sports participation goes beyond physical health, fostering emotional well-being and social skills in a structured, enjoyable setting. Data source: National Survey of Children’s Health, Health Resources and Services Administration, Maternal and Child Health Bureau.
- Access to Recreation Centers: Safe and engaging recreational facilities are crucial for encouraging physical activity. This indicator measures the percentage of children with access to recreation centers in their neighborhoods. Data source: National Survey of Children’s Health, Health Resources and Services Administration, Maternal and Child Health Bureau.
- Meeting CDC Physical Activity Guidelines: The CDC recommends at least 60 minutes of daily physical activity for children. This indicator reflects the percentage of children meeting these guidelines, providing insight into overall community health and infrastructure. Data source: National Survey of Children’s Health, Health Resources and Services Administration, Maternal and Child Health Bureau.
- Unified or Adapted Boys’ Basketball Programs: Basketball is the sport with the highest participation rate among high school students nationwide. This indicator measures the percentage of high schools in the state that sponsor unified or adapted boys’ basketball programs out of the total high schools in the state that sponsor boys’ basketball programs. Data source: The National Federation of State High School Associations (NFHS) 2023-24 High School Athletics Participation Survey.
- Unified or Adapted Girls’ Basketball Programs: Similar to the boys’ metric, this indicator evaluates the inclusivity of basketball programs for girls, emphasizing equity in sports opportunities. Data source: The National Federation of State High School Associations (NFHS) 2023-24 High School Athletics Participation Survey.