Introduction: Adaptive physical activity (APA) for people with physical disabilities was researched. Barriers to participation were identified, along with potential solutions. The role of occupational therapists in enabling participation in APA was explored. Method: A literature review, using a systematic approach, highlighted a number of barriers to participation. Each article was critically analysed using the Critical Appraisal Skills Programme tool. The information was summarised and analysed, using an iterative approach to identify themes. Findings: Eleven key articles were retrieved from the search and two key themes emerged. The first theme encompassed barriers to participation, lack of role models, family attitudes and transportation. The second theme identified potential solutions through integrating APA into health care interventions. Conclusion: Participation in APA improves physical, social and psychological skills, which in turn impacts on other occupations. There is a role for occupational therapists to enable participation in APA by using their core skills of assessment, collaboration, engagement, adaptation, education and advocating for children and young people. APA is an occupation for many children and adolescents, but there are barriers to participation for individuals with disabilities who are seeking to start APA. Occupational therapists have the skills and knowledge to enable an individual to participate in APA.