Physical education ban: children with diabetes are not allowed to play sports
Contradictions in medical documents prevent children with diabetes from attending school physical education classes, going to sections and participating in competitions, Izvestia found out. Often, the assigned health group becomes an obstacle, which is often determined without taking into account the real condition of the child. At the same time, endocrinologists consider sports to be an important part of the treatment of the disease and see no reason to automatically exclude such children from exercise. Why the diagnosis restricts activity and how to change the admission procedure is in the Izvestia article.
Why are there difficulties?
The issue of admission of children with diabetes to physical education and sports has been the subject of appeals to the Ministry of Health. Deputies and representatives of patient organizations are asking the department to eliminate contradictions in regulations, which may deprive minors of the opportunity to engage in physical activity. Izvestia has the documents.
The reason, according to public figures, is the discrepancies in the definition of a health group. Thus, the order of the Ministry of Health of December 30, 2003 No. 621 explicitly refers children with disabilities to group V, which often becomes an obstacle to sports activities, even if they feel well. At the same time, in order No. 211n dated April 14, 2025, the category "disabled child" was excluded from the description of group V: the minor's condition should be assessed individually.
— In polyclinics, children with disabilities are still automatically assigned the V health group, without taking into account their illness and real condition. This restricts their right to engage in physical education and sports, communicate with peers and undergo rehabilitation," Natalia Kostenko, the author of the appeal, told Izvestia.
The problem became especially acute after 2019, when the procedure for establishing disability before the age of 18 was fixed for all children with newly diagnosed type 1 diabetes, she noted. On the one hand, this status entitles to social support, provision of insulin and medical products. On the other hand, due to the automatic assignment of the V health group, it prevents children from playing sports, even if diabetes is under control, the deputy believes.
— It is necessary to eliminate contradictions in the documents and supplement the order of the Ministry of Health No. 211n with clear rules for determining the health group and admission to physical education, taking into account the diagnosis and condition of the child. This will help doctors make decisions based on uniform criteria and protect the interests of children," Natalia Kostenko emphasized.
Yulia Pankova, Project Director at ANO Diaresurs, believes that, in addition to eliminating legal discrepancies, it is necessary to send clarifications to the regions and give pediatricians an understandable decision-making algorithm. According to her, the presence of disability should not replace the assessment of the child's condition. And the consequences of failures go beyond medical limitations.
— The "not allowed" stamp isolates the child from peers, generates complexes and closes the doors to physical education at school and sports sections, — Yulia Pankova explained.
According to the All-Russian Organization of Parents of Disabled Children (VORDI), it has become more difficult to get admission to classes in sections in the Irkutsk Region this year, and children with diabetes are practically not allowed to compete. Difficulties are also encountered in the Trans-Baikal Territory.
In the Lipetsk region, most children with diabetes are assigned the V health group. However, Lipetsk has recently begun conducting in-depth examinations, based on the results of which the issue of admission to the section is being resolved.
In the Nenets Autonomous Okrug, children with compensated diabetes are not officially denied physical education classes. The endocrinologists of the region are concerned only about swimming, said VORDI.
The Ministry of Health confirmed to Izvestia that they had received an appeal from Diaresurs.
"Applicants will be notified of the results of the review in due course," they added.
What problems do families face?
Natalia's 11-year-old son from Ivanovo, who was involved in football, was diagnosed with diabetes in the summer. The parents immediately notified the sports school about the disease.
— The coach said that he is waiting for us to train as soon as we are discharged from the hospital. Previously, he had a boy with the same diagnosis in his team, so he knew how to work with such children," Natalia said.
According to her, her son underwent an in-depth medical examination, but the sports medicine doctor refused admission, despite the recommendations of the endocrinologist.
— She said that the road to sports is now closed. The child was very upset," Natalia said.
Alexander Koshelev's 11-year-old son from St. Petersburg was not allowed to compete in volleyball. After the diagnosis, the boy trained for four years. But to participate in the competition, it took the conclusion of a sports dispensary. The commission refused admission, citing the risk of hypoglycemia, the injury rate of volleyball and the lack of information about whether the staff of the sports school will be able to provide the necessary assistance to the child.
Alexander confirmed that his son has rare episodes of hypoglycemia, but there have been no severe cases. He intends to appeal the commission's decision.
— During the four years of classes, my son had no health problems. Moreover, on training days, glucose levels are more stable throughout the day," Alexander said.
Veronica faced a similar problem. Her daughter has been playing sports for several years and has a degree. Last year, the girl was diagnosed with diabetes.
"The sports doctor refused because my daughter has a V—group of health, established in connection with a registered disability for type 1 diabetes," the mother said.
Veronika appealed to the regional Ministry of Health, the Commissioner for Children's Rights, Roszdravnadzor and the prosecutor's office. After that, another commission was appointed. According to the mother, the experts' conclusions confirmed the possibility of classes under the condition of glycemic control.
"I perfectly understand all the risks, and I have always insisted on a full examination," she stressed. — For more than a year, sugar has been kept within the acceptable range, including through sports.
Some families manage to challenge the assigned health group. So, Alexandra's 11-year-old son from the Nizhny Novgorod region was engaged in acrobatic rock and roll and joined the regional national team. But it wasn't easy to get a sports permit.
— In the end, I got the clinic to identify the III health group — my child in the compensation stage fits it, — said Alexandra.
Others have to change their sport. Inna's son was selected for a diving sports school, but did not receive the admission required for enrollment. Now he is engaged in breakdancing: according to his mother, they do not require a conclusion from a sports dispensary yet.
However, an obstacle may be not only the lack of a medical permit, but also the position of a teacher or coach. Maria faced the instructor's refusal when she wanted to enroll her child in hand-to-hand combat. Yulia's son has been banned from physical education at school since fifth grade, although there were no such restrictions before.
— I didn't insist: I was afraid that he might give some kind of extra load, — said Yulia.
In her opinion, this attitude makes a child stand out from his classmates and makes him feel like "on the bench."
Restrictions may continue after adulthood. Irina's daughter from the Samara region, after enrolling in medical school, was first assigned to a special group for Nordic walking and stretching, and then, according to her mother, only checkers was allowed.
"They get these checkers, no one knows how to play, they just sit on chairs for two hours," Irina said.
The right to an individual approach
Parents interviewed by Izvestia attributed the refusals to the doctors' unwillingness to take responsibility. However, deterioration of the condition during training or competition does not necessarily mean that the doctor made a mistake in granting admission, explained medical lawyer Irina Gritsenko.
"If the question of liability for harm is raised, they find out what information the doctor had about the child's condition at the time of the examination, whether he performed the necessary examinations, whether he took into account contraindications to a specific load and whether the detected violation is related to the consequences," she said.
The actions of the organizer of the competition, who is obliged to provide medical assistance to the participants, are evaluated separately, the expert added.
According to the lawyer, determining the health group and obtaining admission to classes are different procedures. During the preventive examination, Order No. 211n is currently being applied, which provides for an individual assessment.
— The doctor determines the group based on the child's condition, taking into account how diabetes is going and whether there are complications. The medical grounds provided for by this order are needed for the V group," she explained.
The admission procedure also depends on the type of classes, Irina Gritsenko explained. Order No. 484n defines when a child with a disability needs to be examined by a sports doctor, but the rules for regular sections need to be clarified.
— It is necessary to directly indicate which doctor issues admission if classes are held outside the sports training program, — she noted.
And to resolve the issue with the V group of health, according to the lawyer, the explanations of the Ministry of Health are enough: the current procedure already requires assessing the condition of each child individually.
Is exercise useful for diabetes
By itself, type 1 diabetes does not automatically mean a ban on physical education, sports and participation in competitions, said Elena Likhanova, a pediatric endocrinologist and pediatrician.
— Physical activity is an important component of the treatment of this disease. The exclusion of a child from sports life solely on the basis of a diagnosis or disability does not have sufficient medical justification," she stressed.
According to the doctor, this approach is reflected in international recommendations. Regular exercise increases the sensitivity of tissues to insulin, strengthens the cardiovascular system, muscles and bones, and also has a beneficial effect on mood, self-esteem and socialization, she added.
After adapting to the disease and normalizing glucose levels, children can return to physical education and sports, explained Natalia Apellesova, an endocrinologist at the children's clinic "Be Healthy" on Sushchevsky Val. The condition of compensation is assessed by a pediatric endocrinologist.
—Physical activity has a beneficial effect on the course of the disease," she explained.
The main risks are related to changes in the body's need for insulin and fluctuations in glucose, Elena Likhanova emphasized.
— One of the most serious dangers is hypoglycemia, that is, a decrease in blood glucose levels. It can occur during a workout, immediately after it, or after a few hours. After physical activity, increased insulin sensitivity can persist for up to 24 hours, she said.
But physical activity does not always lead to a decrease in blood sugar. After intense exercise, its level may, on the contrary, temporarily increase. However, this does not mean that sports are dangerous or diabetes is poorly controlled, explained Elena Likhanova.
When exercising, it is important to consider other risks associated with the use of medical devices. For example, during contact training, the insulin pump or continuous glucose monitoring sensor may become damaged or disconnected. Therefore, it is necessary to think in advance how to secure them. For swimming, it is important to consider how to ensure the intake of insulin and control glucose levels, the doctor added.
Children with diabetes are not recommended to take classes during which adults cannot constantly monitor them, such as orienteering and yachting, Natalia Apellesova added. There will be no one to help in an emergency, she explained.
As for admission to competitions, some children are not given it because of the severe stress that such events can cause, Natalia Apellesova noted. The hormones produced at the same time often interfere with maintaining glucose levels within the target limits.
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