"I sit all of the time": Health-related time-use among adults with intellectual disabilities

Understanding capabilities, opportunities and motivations to engage in physical activity for adults with intellectual disabilities: A qualitative evidence synthesis

BACKGROUND

There is a paucity of theory-informed physical activity research with adults with intellectual disabilities. This study aimed to address this by synthesising existing literature and applying the COM-B model to understand capabilities, opportunities and motivations.

METHODS

A qualitative evidence synthesis was conducted and reported in accordance with PRISMA guidelines and the ENTREQ. Three databases were systematically searched up to and including February 2022. Qualitative research relating to the physical activity of adults with intellectual disabilities were included. Thematic synthesis was conducted with themes mapped onto the COM-B model.

RESULTS

Twenty-five studies were included. Influences of physical activity were identified and mapped onto the COM-B model, which also included COM-B influences of social support provided by caregivers.

CONCLUSIONS

There are many complex influences of physical activity for adults with intellectual disabilities. Researchers should consider the influences contributing to caregivers' capacity to support physical activity.

Behavioural sleep problems in children and adults with intellectual disabilities: An integrative literature review

BACKGROUND

People with intellectual disabilities are more likely to experience sleep problems, which can affect quality of life, physical health, mental health and well-being.

METHODS

An integrative literature review was conducted to investigate what is known about behavioural sleep disturbances in people with an intellectual disability. The search used the following databases: Scopus, PsycInfo and Cinahl, to find papers published since 2015.

RESULTS

Within intellectual disability research, sleep appears as a common issue due to its high prevalence, negative relationships with an individual's physical and mental health, their quality of life, and impact of sleep problems on family or carers. The growing evidence base appears to support the use of behavioural, lifestyle and pharmacological interventions to improve sleep in people with an intellectual disability.

CONCLUSION

A wide array of literature provides evidence that people with intellectual disabilities are affected by and need support with their sleep.

Recommending Physical Activity for People with Intellectual Disabilities: The Relevance of Public Health Guidelines, Physical Activity Behaviour and Type of Contact

People with an intellectual disability (ID) often exhibit more sedentary behaviour and are less physically active than the general population. While previous public health guidelines on physical activity (PA) did not specifically address the needs of people with an ID, the recent updates now include this population, with recommendations similar to those for the general population. However, it is unclear whether the information about these guidelines has reached the broader public and what factors may influence their implementation. To investigate these issues, an online survey was conducted in Austria, Germany and Switzerland, which examined the (a) PA recommendation for people with an ID, (b) awareness of current guidelines, (c) participants' own PA behaviour (IPAQ-SF) and (d) specific contact with people with an ID. Participants (n = 585) recommended similar levels of PA for people with an ID as for the general population, but knowledge of the guidelines did not affect their recommendation. However, participants' own PA behaviour and context-specific contact (e.g., in family or at work) were associated with the recommended PA levels. Therefore, promoting the relevance of PA and fostering contact with people with an ID might be suitable ways to increase PA in people with an ID.

Factors Related to Physical Activity in Adults With Intellectual Disabilities in Group Home Settings: A Systematic Literature Review

This systematic review of literature aimed to synthesize the multilevel factors related to physical activity (PA) among adults (age 18-65) with intellectual disability living in group homes. Keyword searches were used to identify articles from electronic databases, resulting in the inclusion of 10 articles for full-text review. Data were extracted relating to study and sample characteristics and study findings. Methodological quality of the studies was also evaluated. Factors related to PA in group homes were identified at all levels of the social-ecological model. Intrapersonal factors (e.g., health and functional status, attitude to PA), interpersonal factors (e.g., staff attitude, encouragement for PA, and coparticipation in PA), and organizational factors (e.g., program offerings, staff education, and staff-client ratios) were prominent findings in the reviewed studies. The findings support a social-ecological approach for PA promotion in group homes that target intrapersonal, interpersonal, and organizational factors.

The relationship between direct care providers' physical activity behaviour and perceived physical activity needs for people with intellectual disabilities

BACKGROUND

The promotion of physical activity and the decrease of inactivity and sedentary behaviour are crucial for a healthy lifestyle and positive quality of life. People with intellectual disabilities are at increased risk of inactivity and sedentary behaviour. Therefore, it is important to increase their physical activity by implementing physical activity guidelines in their daily life. Professional direct care providers can play a decisive role in supporting people with intellectual disabilities to participate in physical activity, but the engagement of direct care providers with this role may be reflective of their own attitudes and beliefs towards physical activity. Therefore, the link between the implementation of current physical activity guidelines for people with intellectual disabilities and direct care providers' own beliefs and behaviour with regard to physical activity is investigated.

METHOD

A total of 104 direct care providers completed self-reported questionnaires about their own physical activity behaviour (IPAQ-SF), recommendations for people with intellectual disabilities (adaption of EMIQ-HP) and questions regarding global physical activity guidelines. They were also asked about potential barriers and facilitators for the recommendation of physical activity in open-ended questions.

RESULTS

Personal physical activity behaviour is related to the recommended physical activity for people with intellectual disabilities (moderate-to-vigorous physical activity: r_s  = 0.408, P = 0.005). However, recommended physical activity behaviour for people with intellectual disabilities is significantly lower than direct care providers' own physical activity behaviour (P < 0.001). 47.1% of the respondents recommended people with intellectual disabilities to participate in less than the 150 min of moderate intensity physical activity per week for that is recommended in global physical activity guidelines.

CONCLUSION

Direct care providers may hold stereotypical views and insecurities about the potential harms associated with people with intellectual disabilities participating in physical activity. Therefore, the dissemination of physical activity recommendations for people with intellectual disabilities should be a major target for health professionals, social workers and scientists to address direct care providers' concerns. Furthermore, we need to emphasise the benefits of regular physical activity to professional direct care providers and directly to people with intellectual disabilities.

Engaging and sustaining people with intellectual disabilities in physical activity: a narrative review of existing evidence

Background: People with intellectual disabilities (ID) experience many health and social inequalities. Increasing physical activity is a proven intervention to address such inequalities, yet the physical activity rates of this population are substantially lower than the general population. Aim: Research has been growing to understand why this is and how to intervene to increase the physical activity levels of people with ID. Method: Using a behavioural epidemiological framework, the research in this area from barriers and facilitators of physical activity to translational research testing interventions within natural settings is reviewed. Findings from a total of 14 reviews and eight empirical studies and protocols were included. Results: Whilst there are multiple investigations into what promotes or enhances physical activity for people with ID, findings from intervention studies show few successful outcomes. Gaps within the existing research are identified and recommendations about how intervention efficacy might be improved are provided to inform future research and practice. Conclusion: Findings from previous research on barriers and facilitators can be further capitalised on and intervention studies should be underpinned by better links to theory and more systemic approaches.

Identifying the most proximal multi-level factors associated with meeting each of the 24-h movement behavior recommendations in a sample of autistic adults

BACKGROUND

Autistic adults have poorer 24-h movement behaviors, including lower levels of physical activity, more time spent being sedentary, and shorter sleep duration than neurotypical adults. Social ecological frameworks posit that 24-h movement behaviors are determined by multi-level domains; however, not known is which multi-level factors are most important to meeting each of the 24-h movement behavior guidelines among autistic adults.

OBJECTIVE

This study examined the relative importance of a range of multi-level determinants on meeting guidelines for the 24-h movement behaviors of aerobic physical activity, sedentary behavior, and sleep.

METHODS

We administered at cross-sectional electronic survey to a national self-selecting, convenience sample of autistic adults and caregivers of autistic adults residing in the USA. We used machine learning to examine the relative variable importance (VIMP) of 55 multi-level variables with meeting recommendations for physical activity, sedentary behavior, and sleep duration. VIMPs >0 indicate predictive variables/domains.

RESULTS

A greater number of group activities attended in the last 3-months, and greater independence in completing activities of daily living were most important to meeting aerobic physical activity guidelines. Group activity participation and marital status were important to meeting sedentary behavior guidelines while having a fewer number of comorbidities was most important to achieving adequate sleep.

CONCLUSIONS

These data support hypotheses about the role of family and social level interventions targeting movement behaviors in autistic adults.

24-Hour Movement Behaviors Among US Adults With Functional Disabilities

This study aimed to quantify and compare physical activity, sitting time, and sleep behaviors among US adults with and without disabilities using the 2020 Canadian 24-hour movement framework. The weighted prevalence of 24-hour movement guideline adherence was estimated among a nationally representative sample from the 2017 to 2018 National Health and Nutrition Examination Survey of US adults (18-65 years old) with (n = 1070) and without (n = 33,370) functional disabilities in vision, hearing, mobility, cognitive, and self-care domains. The adjusted odds of single and combination guideline compliance were estimated by disability type, in reference to adults without disabilities, using separate multivariable logistic regressions. After adjusting for age, sex, and income, adults with disabilities in mobility, cognitive, or self-care domains had approximately half the odds of meeting all 3 guidelines, compared with adults without disabilities (adjusted odds range: 0.49-0.77). Significantly lower adherence was observed among adults with functional disabilities, compared with no disabilities, for sleep, and moderate to vigorous physical activity, but not sedentary guidelines. This report establishes baseline prevalence estimates for guidelines compliance among US adults with functional disabilities ages 18-65 years old. Low guideline adherence, and evidence for significant differences in physical activity and sleep, signals a need to further explore combination health behaviors among adults with disabilities.

Empirically supported psychological treatments: The challenges of comorbid psychiatric and behavioral disorders in people with intellectual disability

This paper reviews the current state of knowledge on psychological interventions with empirical evidence of efficacy in treating common psychiatric and behavioral disorders in people with intellectual disability (ID) at all stages of their life. We begin with a brief presentation of what is meant by psychiatric and behavioral disorders in this population, along with an explanation of some of the factors that contribute to the increased psychosocial vulnerability of this group to present with these problems. We then conduct a review of empirically supported psychological therapies used to treat psychiatric and behavioral disorders in people with ID. The review is structured around the three generations of therapies: Applied behavior analysis (e.g., positive behavior support), cognitive behavioral therapies (e.g., mindfulness-based cognitive therapy), and contextual therapies (e.g., dialectical behavior therapy). We conclude with some recommendations for professional practice in the fields of ID and psychiatry.