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Rana D, Westrop S, Jaiswal N, Germeni E, McGarty A, Ells L, Lally P, McEwan M, Melville C, Harris L, Wu O. Lifestyle modification interventions for adults with intellectual disabilities: systematic review and meta-analysis at intervention and component levels. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:387-445. [PMID: 38414293 DOI: 10.1111/jir.13098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/26/2023] [Accepted: 09/26/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND Adults with intellectual disabilities (IDs) are susceptible to multiple health risk behaviours such as alcohol consumption, smoking, low physical activity, sedentary behaviour and poor diet. Lifestyle modification interventions can prevent or reduce negative health consequences caused by these behaviours. We aim to determine the effectiveness of lifestyle modification interventions and their components in targeting health risk behaviours in adults with IDs. METHODS A systematic review and meta-analysis were conducted. Electronic databases, clinical trial registries, grey literature and citations of systematic reviews and included studies were searched in January 2021 (updated February 2022). Randomised controlled trials and non-randomised controlled trials targeting alcohol consumption, smoking, low physical activity, sedentary behaviours and poor diet in adults (aged ≥ 18 years) with ID were included. Meta-analysis was conducted at the intervention level (pairwise and network meta-analysis) and the component-level (component network meta-analysis). Studies were coded using Michie's 19-item theory coding scheme and 94-item behaviour change taxonomies. Risk of bias was assessed using the Cochrane Risk of Bias (ROB) Version 2 and Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I). The study involved a patient and public involvement (PPI) group, including people with lived experience, who contributed extensively by shaping the methodology, providing valuable insights in interpreting results and organising of dissemination events. RESULTS Our literature search identified 12 180 articles, of which 80 studies with 4805 participants were included in the review. The complexity of lifestyle modification intervention was dismantled by identifying six core components that influenced outcomes. Interventions targeting single or multiple health risk behaviours could have a single or combination of multiple core-components. Interventions (2 RCTS; 4 non-RCTs; 228 participants) targeting alcohol consumption and smoking behaviour were effective but based on limited evidence. Similarly, interventions targeting low physical activity only (16 RCTs; 17 non-RCTs; 1413 participants) or multiple behaviours (low physical activity only, sedentary behaviours and poor diet) (17 RCTs; 24 non-RCTs; 3164 participants) yielded mixed effectiveness in outcomes. Most interventions targeting low physical activity only or multiple behaviours generated positive effects on various outcomes while some interventions led to no change or worsened outcomes, which could be attributed to the presence of a single core-component or a combination of similar core components in interventions. The intervention-level meta-analysis for weight management outcomes showed that none of the interventions were associated with a statistically significant change in outcomes when compared with treatment-as-usual and each other. Interventions with core-components combination of energy deficit diet, aerobic exercise and behaviour change techniques showed the highest weight loss [mean difference (MD) = -3.61, 95% credible interval (CrI) -9.68 to 1.95] and those with core-components combination dietary advice and aerobic exercise showed a weight gain (MD 0.94, 95% CrI -3.93 to 4.91). Similar findings were found with the component network meta-analysis for which additional components were identified. Most studies had a high and moderate risk of bias. Various theories and behaviour change techniques were used in intervention development and adaptation. CONCLUSION Our systematic review is the first to comprehensively explore lifestyle modification interventions targeting a range of single and multiple health risk behaviours in adults with ID, co-produced with people with lived experience. It has practical implications for future research as it highlights the importance of mixed-methods research in understanding lifestyle modification interventions and the need for population-specific improvements in the field (e.g., tailored interventions, development of evaluation instruments or tools, use of rigorous research methodologies and comprehensive reporting frameworks). Wide dissemination of related knowledge and the involvement of PPI groups, including people with lived experience, will help future researchers design interventions that consider the unique needs, desires and abilities of people with ID.
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Affiliation(s)
- D Rana
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - S Westrop
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Mental Health and Wellbeing, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - N Jaiswal
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - E Germeni
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - A McGarty
- Mental Health and Wellbeing, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - L Ells
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK
| | - P Lally
- UCL Institute of Epidemiology and Health Care, University College London, London, UK
- Department of Psychology, University of Surrey, Guildford, UK
| | - M McEwan
- People First (Scotland), Edinburgh, UK
| | - C Melville
- Mental Health and Wellbeing, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - L Harris
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - O Wu
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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2
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Gibson CA, Sullivan DK, Ptomey LT, Rice AM, Donnelly JE. Interviews with parents of adolescents with intellectual and developmental disabilities in a weight management study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:289-299. [PMID: 36453027 DOI: 10.1111/jar.13058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/05/2022] [Accepted: 11/12/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Adolescents and young adults with intellectual and developmental disabilities are at risk of obesity. Parents influence their diet and physical activity behaviours and therefore, can play important roles in weight management. The aims of this qualitative study were to explore parents' experiences assisting their son or daughter to participate in a weight management study. METHODS Interviews were completed at 6 months with 27 parents whose adolescent or young adult had completed the weight loss portion of an 18-month weight management study. Interviews were recorded, transcribed and thematic analysis performed. RESULTS Parents shared insights about how well program components worked with their family, and what strategies worked best to adopt healthier dietary choices and become more physically active. The importance of meeting regularly with someone outside the family to encourage healthier habits was stressed. CONCLUSIONS Future weight management studies should involve parents and their adolescents to help tailor strategies and adapt intervention approaches.
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Affiliation(s)
- Cheryl A Gibson
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Lauren T Ptomey
- Department of Internal Medicine, Division of Physical Activity and Weight Management, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Anna M Rice
- Department of Internal Medicine, Division of Physical Activity and Weight Management, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Joseph E Donnelly
- Department of Internal Medicine, Division of Physical Activity and Weight Management, University of Kansas Medical Center, Kansas City, Kansas, USA
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3
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Salse‐Batán J, Sanchez‐Lastra MA, Suárez‐Iglesias D, Pérez CA. Effects of exercise training on obesity-related parameters in people with intellectual disabilities: systematic review and meta-analysis. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:413-441. [PMID: 35297122 PMCID: PMC9314046 DOI: 10.1111/jir.12928] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 05/19/2023]
Abstract
BACKGROUND Efforts to synthesise existing knowledge concerning the effects of exercise interventions on obesity (i.e. changes in body weight and composition) have been made, but scientific evidence in this matter is still limited. This systematic review and meta-analysis aims to identify and critically analyse the best available evidence regarding the use of physical exercise as a strategy to attenuate obesity through its effects on adiposity-related anthropometric parameters in people with intellectual disability (ID). METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a literature search was performed using PubMed, Scopus, SPORTDiscus, CINAHL and the Cochrane Library through specific keywords up to July 2020. The search adhered to the population, intervention, comparison and outcome strategy. Randomised controlled trials addressing the effects of the exercise intervention on adiposity-related anthropometric parameters (body mass index, waist circumference, waist-hip ratio, fat percentage or body weight) in children, adolescents and adults with ID were included. The methodological quality of the studies found was evaluated through the PEDro scale. RESULTS A total of nine investigations with children and/or adolescents (10-19 years) and 10 investigations with adults (18-70 years) were selected, mostly experiencing mild and moderate ID. Methodological quality was fair in 13 of these publications, good in five and excellent in one. Seventeen trials reported comparable baseline and post-intervention data for the intervention and control groups and were included in the meta-analysis. In nine studies, the intervention group performed a cardiovascular training programme. Five papers described a combined training programme. Two trials executed whole-body vibration training programmes, and one publication proposed balance training as the primary intervention. According to the meta-analysis results, the reviewed studies proposed exercise modalities that, in comparison with the activities performed by the participants' in the respective control groups, did not have a greater impact on the variables assessed. CONCLUSIONS While physical exercise can contribute to adiposity-related anthropometric parameters in people with mild and moderate ID, these findings show that exercise alone is not sufficient to manage obesity in this population. Multicomponent interventions appear to be the best choice when they incorporate dietary deficit, physical activity increase and behaviour change strategies. Finding the most effective modality of physical exercise can only aid weight loss interventions. Future research would benefit from comparing the effects of different exercise modalities within the framework of a multicomponent weight management intervention.
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Affiliation(s)
- J. Salse‐Batán
- Institut Nacional d'Educació Física de Catalunya (INEFC)Universitat de Barcelona (UB)BarcelonaSpain
| | - M. A. Sanchez‐Lastra
- Grupo de Investigación Wellness and Movement, Departamento de Didácticas Especiais, Facultade de Ciencias da Educación e do DeporteUniversidade de VigoPontevedraSpain
- Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur)Sergas‐UVIGOVigoSpain
| | - D. Suárez‐Iglesias
- VALFIS Research Group, Institute of Biomedicine (IBIOMED), Faculty of Physical Activity and Sports SciencesUniversity of LeónLeónSpain
| | - C. Ayán Pérez
- Grupo de Investigación Wellness and Movement, Departamento de Didácticas Especiais, Facultade de Ciencias da Educación e do DeporteUniversidade de VigoPontevedraSpain
- Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur)Sergas‐UVIGOVigoSpain
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Ptomey LT, Oreskovic NM, Hendrix JA, Nichols D, Agiovlasitis S. Weight management recommendations for youth with Down syndrome: Expert recommendations. Front Pediatr 2022; 10:1064108. [PMID: 36819200 PMCID: PMC9937587 DOI: 10.3389/fped.2022.1064108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/30/2022] [Indexed: 02/05/2023] Open
Abstract
Youth with Down syndrome (DS) have a higher prevalence of overweight and obesity compared to the general youth population. Due to physiological and cognitive differences observed in youth with DS, weight management recommendations developed for the general population, may not be suitable for youth with DS. However, there are no recent recommendations for weight management in youth with DS. A workgroup of clinicians and researchers with extensive experience working with youth with DS came together to give clinicians and families guidance for weight management in youth with DS. Recommendations were developed by the workgroup via a methodical, deliberative process. After the initial development of the recommendations, they were shared with an expert review panel and caregivers who rated the strength of the recommendation and strength of the evidence. The workgroup moved forward the recommendations which the review panels rated as strong. Eight recommendations were developed which focused on screening for overweight and obesity, screening for health conditions that may impact dietary intake and physical activity, screening for feeding difficulties, setting appropriate recommendations for dietary intake and physical activity, and well as prevention and treatment of overweight and obesity using evidence-based strategies. These recommendations can be implemented by clinicians working with youth with Down syndrome as well as the family, school, and other relevant entities.
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Affiliation(s)
- Lauren T Ptomey
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Nicolas M Oreskovic
- Departments of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | | | - Dominica Nichols
- Departments of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Stamatis Agiovlasitis
- Department of Kinesiology, Mississippi State University, Mississippi State, MS, United States
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5
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Skelly LJ, Smyth PP, Donnelly MP, Leslie JC, Leader G, Simpson L, McDowell C. Factors that potentially influence successful weight loss for adults with intellectual disabilities: A qualitative comparison. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2021; 25:458-475. [PMID: 32578470 PMCID: PMC8649414 DOI: 10.1177/1744629520931681] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/10/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND People with intellectual disabilities are more at risk of obesity than the general population. Emerging literature indicates that multicomponent interventions are most effective, however, individual results are variable and little research exists as to why this is the case. METHODS Focus groups were conducted to explore lived experiences between two groups of adults with intellectual disabilities; an overweight group (n = 6) and a group identified as successful in losing weight (n = 6). Similarities and differences were explored across four domains. Transcripts were produced and analysed using Theoretical Thematic Analysis. RESULTS Similarities included service centre supports, basic food knowledge and issues restricting independence. The successful weight loss group had also internalised health messages, engaged with external reinforcement programmes, responded to positive feedback and demonstrated healthier dietary habits. CONCLUSION Weight management interventions would benefit from understanding the influence that internalisation of health messages, effective reinforcement systems and positive feedback can have on supporting the adoption of healthier habits.
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Affiliation(s)
| | - Philomena P Smyth
- Ulster University, UK; National University of
Ireland Galway, Ireland
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6
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Lally P, Beeken RJ, Wilson R, Omar R, Hunter R, Fovargue S, Anderson D, King M, Hassiotis A, Croker H. A manualised weight management programme for adults with mild-moderate intellectual disabilities affected by excess weight: A randomised controlled feasibility trial (Shape Up-LD). JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:112-122. [PMID: 34297441 DOI: 10.1111/jar.12922] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 05/11/2021] [Accepted: 05/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim was to pilot an adapted manualised weight management programme for persons with mild-moderate intellectual disabilities affected by overweight or obesity ('Shape Up-LD'). METHOD Adults with intellectual disabilities were enrolled in a 6-month trial (3-month active intervention and 3-month follow-up) and were individually randomised to Shape Up-LD or a usual care control. Feasibility outcomes included recruitment, retention, initial effectiveness and cost. RESULTS Fifty people were enrolled. Follow-up rates were 78% at 3 months and 74% at 6 months. At 3 and 6 months, controlling for baseline weight, no difference was observed between groups (3 months: β: -0.34, 95% confidence interval [CI]: -2.38, 1.69, 6 months: β: -0.55, 95%CI -4.34, 3.24). CONCLUSION It may be possible to carry out a trial of Shape Up-LD, although barriers to recruitment, carer engagement and questionnaire completion need to be addressed, alongside refinements to the intervention.
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Affiliation(s)
- Phillippa Lally
- Department of Behavioural Science and Health, University College London, London, UK
| | - Rebecca J Beeken
- Department of Behavioural Science and Health, University College London, London, UK.,Leeds Institute of Health Sciences, London, UK
| | - Rose Wilson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Rumana Omar
- Department of Statistical Science, University College London, London, UK
| | - Rachael Hunter
- Department of Primary Care & Population Health, University College London, London, UK.,Priment Clinical Trials Unit, London, UK
| | | | | | - Michael King
- Division of Psychiatry, University College London, London, UK
| | | | - Helen Croker
- Department of Behavioural Science and Health, University College London, London, UK
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Milroy JJ, Oakes LR, Hickerson BD. Design Thinking: Assessing the health needs of college students with intellectual and/or developmental disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:1408-1420. [PMID: 33742525 DOI: 10.1111/jar.12882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 02/11/2021] [Accepted: 03/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a dearth of literature related to well-being of college students with IDD. The purpose of this study was to use design thinking to identify health-related innovations for college students with IDD. METHOD Two design thinking events were conducted with participants (n = 16). Subsequent web-based surveys with a separate group of students with IDD (n = 18) assessed feasibility of each innovation. Collaborative group discussions were used to assess each innovation, and quantitate data were used to assess innovation feasibility. RESULTS A total of 16 innovations were constructed: 4 sexual health, dating and relationships, 2 drugs and/or alcohol, 2 exercise and physical activity, 2 socializing, leisure and recreation, 2 food and nutrition and 4 mental health. CONCLUSION Design thinking methods are a suitable strategy to use with individuals with IDD and led to the development of innovations with high relevancy and feasibility for college students with IDD.
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Affiliation(s)
- Jeffrey J Milroy
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Lindsey R Oakes
- Department of Health and Human Performance, Texas State University, San Marcos, TX, USA
| | - Benjamin D Hickerson
- Department of Community and Therapeutic Recreation, University of North Carolina Greensboro, Greensboro, NC, USA
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8
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Taggart L, Doherty AJ, Chauhan U, Hassiotis A. An exploration of lifestyle/obesity programmes for adults with intellectual disabilities through a realist lens: Impact of a 'context, mechanism and outcome' evaluation. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:578-593. [PMID: 33342030 DOI: 10.1111/jar.12826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 07/16/2020] [Accepted: 10/05/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Obesity is higher in people with intellectual disabilities. AIMS There are two aims of this explorative paper. Firstly, using a realist lens, to go beyond 'what works' and examine the 'context, mechanisms and outcomes' (CMO) of lifestyle/obesity programmes for this population. Second, using a logic model framework to inform how these programmes could be implemented within practice. METHOD We explored six-review papers and the individual lifestyle/obesity programmes that these papers reviewed using the CMO framework. RESULTS There were few theoretically underpinned, multi-component programmes that were effective in the short to long-term and many failed to explore the 'context and mechanisms'. We developed a logic model and engaged in two co-production workshops to refine this model. DISCUSSION Using a realist approach, programmes need to be underpinned by both individual and systems change theories, be multi-component, have a closer understanding of the interplay of the 'context and mechanisms', and co-designed using a logic model framework.
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Affiliation(s)
- Laurence Taggart
- Institute of Nursing & Health Research, Ulster University, Co Antrim, UK
| | - Alison Jayne Doherty
- Faculty of Health & Wellbeing, University of Central Lancashire (UCLan), Preston, UK
| | - Umesh Chauhan
- Faculty of Health & Wellbeing, University of Central Lancashire (UCLan), Preston, UK
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9
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Røstad-Tollefsen HK, Kolset SO, Retterstøl K, Hesselberg H, Nordstrøm M. Factors influencing the opportunities of supporting staff to promote a healthy diet in adults with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:733-741. [PMID: 33274594 DOI: 10.1111/jar.12846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/13/2020] [Accepted: 11/19/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Adults with intellectual disabilities living in residential houses have a high prevalence of obesity which is related to poor dietary habits. AIM The aim of this study was to assess supporting staff`s thoughts and experiences on factors influencing their opportunities to promote a healthy diet in adults with intellectual disabilities. METHODS 13 supporting staff members were recruited from 11 different residential houses in a community. Concept Mapping methodology was used, including group interviews, sorting, rating statement and analysing the results. RESULTS Seven clusters most accurately captured the ideas of the supporting staff`. 'Attitudes', 'Facilitating a healthy diet', 'Practical cooking skills' and 'Applied dietary knowledge' were the four most important. CONCLUSIONS Multiple factors influence the opportunities of supporting staff to promote a healthy diet. A holistic approach addressing all relevant factors is necessary when developing interventions to address this complex issue in persons with intellectual disabilities.
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Affiliation(s)
- Helen K Røstad-Tollefsen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Baerum Municipality, Health and Care Services, Community Housing and Services, Sandvika, Norway
| | - Svein O Kolset
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Kjetil Retterstøl
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Lipid Clinic, Oslo University Hospital, Oslo, Norway
| | - Heidi Hesselberg
- Baerum Municipality, Health and Care Services, Community Housing and Services, Sandvika, Norway
| | - Marianne Nordstrøm
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Frambu Resource Centre for Rare Disorders, Siggerud, Norway.,Department of Neurology, Unit for Inborn and Hereditary Neuromuscular Disorders, Oslo University Hospital, Oslo, Norway
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Development and Cross-Validation of a Prediction Equation for Estimating Percentage Body Fat From Body Mass Index in Young People With Intellectual Disability. Adapt Phys Activ Q 2020; 37:481-497. [PMID: 32998109 DOI: 10.1123/apaq.2019-0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/11/2020] [Accepted: 03/15/2020] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study was to develop and cross-validate an equation for estimating percentage body fat (%BF) from body mass index and other potential independent variables among young persons with intellectual disability. Participants were 128 persons with intellectual disability (62 women; age 16-24 years) split between development (n = 98) and cross-validation (n = 30) samples. Dual-energy X-ray absorptiometry served as the reference method for %BF. An equation including 1/body mass index and sex (0 = male; 1 = female) was highly accurate in estimating %BF (p < .001; R2 = .82; standard error of estimate = 5.22%). Mean absolute and root mean square errors were small (3.1% and 3.9%, respectively). A Bland-Altman plot indicated nearly zero mean difference between actual and predicted %BF with modest 95% confidence intervals. The prediction equation was %BF = 56.708 - (729.200 × [1/body mass index]) + (12.134 × sex). Health care professionals may use the prediction equation for monitoring %BF among young people with intellectual disability.
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11
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Association between Participation in Annual Physical Examinations and Risk Factors for Noncommunicable Diseases in Adults with Disabilities: Evidence from Shanghai, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113822. [PMID: 32481572 PMCID: PMC7312913 DOI: 10.3390/ijerph17113822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/23/2020] [Accepted: 05/24/2020] [Indexed: 11/17/2022]
Abstract
The relationships between regular participation in annual physical examinations and the risk factors for noncommunicable diseases (NCDs) among adults with disabilities remains unclear. To address this gap, we used data from 130,899 individuals with disabilities in Shanghai (2014–2016) and evaluated four risk factors for NCDs: hypertension, hyperglycemia, hyperlipidemia, and being overweight. Overall, 4540 individuals participated in annual physical examinations across all three years and 11,388 missed examinations in 2015 (group without regular participation). Chi-squared tests and binary logistic regression were used to assess differences in patient characteristics and explore correlations between variables. Significant differences in age (χ2 = 102.620, p < 0.01), place of residence (χ2 = 94.308, p < 0.01), educational level (χ2 = 59.884, p < 0.01), marital status (χ2 = 16.414, p < 0.01) and disability type (χ2 = 56.499, p < 0.01) and severity (χ2 = 45.464, p < 0.01) were found between those who participated in regular physical examinations and those who did not. Regular participation was associated with reduced incidences of hypertension (odds ratio 0.799, 95% confidence interval (CI): 0.733–0.871) and hyperlipidemia (0.347, 95% CI: 0.307–0.392), but not with the incidence of diabetes (1.049, 95% CI: 0.944–1.166) or being overweight (0.907, 95% CI: 0.812–1.014). Hence, regular participation in annual physical examinations had different associations with risk factors for NCDs.
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12
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Rubenstein E, DuBois L, Sadowsky M, Washburn K, Forquer M, Stanish H, Shriver T. Evaluating the potential of Special Olympics fitness models as a health intervention for adults with intellectual disabilities. Disabil Health J 2019; 13:100850. [PMID: 31704231 DOI: 10.1016/j.dhjo.2019.100850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/28/2019] [Accepted: 10/17/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND People with intellectual disabilities (ID) have high prevalence of cardiovascular disease (CVD) risk factors; yet, few behavioral health interventions are designed and implemented for people with ID. OBJECTIVE This study examined Special Olympics Inc. (SOI) fitness models as a potential intervention to reduce CVD risk in people with ID. METHODS Data from SOI fitness models implemented in 2016-2018 were assessed. Special Olympics Programs received funding, resources, and technical assistance from SOI to conduct fitness models centered on inclusive physical activity and goal setting. Weight, body mass index, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured at baseline and 4-12 weeks into the model. Multi-level multivariable quintile linear regression assessed change. RESULTS 383 participants with ID (athletes) and 281 partners without ID met inclusion criteria. Mean weight loss among athletes was 0.67 kg and 132 (31.9%) lost ≥ 1 kg. Blood pressure decreased in SBP quintile 4 (-7.52 mm Hg, 95% confidence interval [CI]: 11.8, -4.0), SBP quintile 5 (-9.52 mm Hg, 95% CI: 13.5, -5.6), and DBP quintile 5 (-7.49 mm Hg, 95% CI: 13.1, -1.9). Partners had similar results. Strongest effects were in a 'high-risk' group that was in the quintile 4 or 5 in all baseline measures. CONCLUSION In fitness models developed to improve fitness for people with ID, there was a reduction in weight and blood pressure. SOI fitness models show promise and potential as a health intervention. This work enables further examination of indicators for successful implementation and evaluation of health.
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Affiliation(s)
- Eric Rubenstein
- Research and Evaluation, Special Olympics International, Washington D.C., USA; Waisman Center, Department of Family Medicine, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI, 53705, USA.
| | - Lindsay DuBois
- Research and Evaluation, Special Olympics International, Washington D.C., USA
| | - Molly Sadowsky
- Research and Evaluation, Special Olympics International, Washington D.C., USA
| | - Kyle Washburn
- Fitness, Special Olympics International, Washington D.C., USA
| | - Monica Forquer
- Fitness, Special Olympics International, Washington D.C., USA
| | - Heidi Stanish
- Fitness, Special Olympics International, Washington D.C., USA; Department of Exercise and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
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Doherty AJ, Jones SP, Chauhan U, Gibson JME. Healthcare practitioners' views and experiences of barriers and facilitators to weight management interventions for adults with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:1067-1077. [PMID: 30983088 DOI: 10.1111/jar.12596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 03/19/2019] [Accepted: 03/21/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Obesity is common in adults with intellectual disabilities, yet little is known about how weight management interventions are provided for this population. METHODS Semi-structured interviews were held with 14 healthcare practitioners involved in weight management interventions in an English county. A study topic guide was developed to elicit practitioners' views and experiences of barriers and facilitators to weight management for adults with intellectual disabilities. Responses were analysed using thematic analysis. RESULTS Several barriers are involved in weight management for people with intellectual disabilities including communication challenges, general practitioners' lack of knowledge and awareness of weight management services, inconsistencies in caring support, resource constraints, wider external circumstances surrounding the individuals and motivational issues. Facilitators include reasonable adjustments to existing weight management services. However, there is a need for specialist weight management provision for people with intellectual disabilities. CONCLUSIONS This study provides suggestions for future research, policy and practice consideration.
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Salomon C, Bellamy J, Evans E, Reid R, Hsu M, Teasdale S, Trollor J. 'Get Healthy!' A physical activity and nutrition program for older adults with intellectual disability: pilot study protocol. Pilot Feasibility Stud 2018; 4:144. [PMID: 30151237 PMCID: PMC6109457 DOI: 10.1186/s40814-018-0333-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/12/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Older adults with intellectual disability have high rates of lifestyle-related illness yet remain poorly engaged in physical activity and nutrition interventions. There is a need to clarify what types of healthy lifestyle interventions are feasible and effective to implement in this population and how outcome measures can best be tracked. This paper describes the pilot feasibility study protocol for implementing a 12-week physical activity and healthy eating program, 'Get Healthy!' with older adults with intellectual disability. METHODS The primary study aims are to assess the feasibility of implementing and monitoring the 'Get Healthy!' program with adults with mild to moderate intellectual disability, aged 40 years and over, and their carers. Secondary study aims are to assess the impact of the intervention across the following parametres: body mass index, waist circumference, cardiovascular fitness, physical activity (amount and intensity) and sedentary behaviours, resting blood pressure, functional strength/capacity, dietary intake (energy intake, food group consumption and diet quality), dietary and physical activity knowledge, and quality of life. Between 8 and 10 participants in total will be recruited into the 12-week program that will be run in metropolitan NSW, Australia. A combination of objective and subjective measures will be used to assess program feasibility and impact at set timepoints (baseline, mid and end-program). DISCUSSION Results from the feasibility pilot will be used to refine the study methodology and 'Get Healthy!' program content for future use in a sufficiently powered trial. Findings may be of interest to a broad range of disability and allied health workers engaged in supporting and monitoring healthy lifestyle change in adults with intellectual disability. TRIAL REGISTRATION ACTRN: ACTRN12618000349246. Registered March 8, 2018- Retrospectively registered, UTN: U1111-1209-3132.
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Affiliation(s)
- Carmela Salomon
- Department of Developmental Disability Neuropsychiatry, 34 Botany St, UNSW Sydney, Sydney, 2052 Australia
| | - Jessica Bellamy
- Department of Developmental Disability Neuropsychiatry, 34 Botany St, UNSW Sydney, Sydney, 2052 Australia
- Department of Exercise Physiology, School of Medical Sciences, Wallace Wurth Level 2, UNSW Sydney, Sydney, 2052 Australia
| | - Elizabeth Evans
- Department of Developmental Disability Neuropsychiatry, 34 Botany St, UNSW Sydney, Sydney, 2052 Australia
| | - Renae Reid
- Department of Developmental Disability Neuropsychiatry, 34 Botany St, UNSW Sydney, Sydney, 2052 Australia
| | - Michelle Hsu
- Department of Developmental Disability Neuropsychiatry, 34 Botany St, UNSW Sydney, Sydney, 2052 Australia
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, 2006 Australia
| | - Scott Teasdale
- Keeping the Body in Mind Program, South Eastern Sydney Local Health District, 26 Llandaff Street, Bondi Junction, 2022 Australia
- School of Psychiatry, UNSW, Hospital Road, Randwick, 2013 Australia
| | - Julian Trollor
- Department of Developmental Disability Neuropsychiatry, 34 Botany St, UNSW Sydney, Sydney, 2052 Australia
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Salomon C, Britt H, Pollack A, Trollor J. Primary care for people with an intellectual disability - what is prescribed? An analysis of medication recommendations from the BEACH dataset. BJGP Open 2018; 2:bjgpopen18X101541. [PMID: 30564718 PMCID: PMC6184100 DOI: 10.3399/bjgpopen18x101541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 02/12/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND People with intellectual disability (ID) experience a range of health disparities. Little is known about differential primary care prescribing patterns for people with and without ID. AIM To compare medications recommended by GPs at encounters where ID is recorded versus other encounters. DESIGN & SETTING Analysis of national Australian GP medication data from the Bettering the Evaluation and Care of Health (BEACH) programme, January 2003-December 2012 inclusive. METHOD Medication recommendations made at encounters where an ID-defining problem was recorded as a reason for encounter (RFE) and/or as a problem managed, were allocated to the 'ID group' (n = 563). These encounters were compared with all other encounters (the 'non-ID group', n = 1 004 095) during the study period. Following age-sex standardisation of ID group encounters, significant differences were determined by non-overlapping 95% confidence intervals (CIs). RESULTS Antipsychotics and anticonvulsants were recommended more frequently at ID group encounters than at non-ID group encounters. Antidepressant and anxiolytic recommendation rates did not differ between groups. Narcotic analgesic and antihypertensive recommendations were significantly lower at ID group encounters. CONCLUSION Higher rates of epilepsy and mental illness, and off-label use of some antipsychotics and anticonvulsants for behaviour management in people with ID, may have contributed to medication recommendations observed in this analysis. Lower narcotic analgesic recommendations at ID group encounters may relate to complex presentations and the nature of problems managed, while lower antihypertensive recommendations may indicate some potential omission of routine blood pressure measurement.
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Affiliation(s)
- Carmela Salomon
- Postdoctoral Project Officer, Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW, Sydney, Australia
| | - Helena Britt
- Professor of Primary Care Research and Director, Family Medicine Research Centre, School of Public Health, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Allan Pollack
- Research Analyst, Family Medicine Research Centre, School of Public Health, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Julian Trollor
- Chair of Intellectual Disability Mental Health and Head of Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW, Sydney, Australia
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Doherty AJ, Jones SP, Chauhan U, Gibson JME. An integrative review of multicomponent weight management interventions for adults with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 31 Suppl 1:39-51. [PMID: 28631874 PMCID: PMC5811836 DOI: 10.1111/jar.12367] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Obesity is more prevalent in people with intellectual disabilities and increases the risk of developing serious medical conditions. UK guidance recommends multicomponent weight management interventions (MCIs), tailored for different population groups. METHODS An integrative review utilizing systematic review methodology was conducted to identify the types of MCIs delivered to adults with intellectual disabilities. FINDINGS Five studies were identified. All of the studies' MCIs were tailored for adults with intellectual disabilities. Tailoring included measures such as simplified communication tools, individualized sessions, and the presence of carers where appropriate. CONCLUSIONS Emerging evidence suggests ways in which MCIs can be tailored for adults with intellectual disabilities but, given the few studies identified, it is not possible to recommend how they can be routinely tailored. Further studies are justified for adults with intellectual disabilities at risk of obesity-related conditions.
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Affiliation(s)
- Alison J. Doherty
- National Institute for Health Research (NIHR)Collaboration for Leadership in Applied Health Research and Care, North West Coast (CLAHRC, NWC)PrestonUK
- School of NursingFaculty of Health & WellbeingUniversity of Central LancashirePrestonUK
| | - Stephanie P. Jones
- School of NursingFaculty of Health & WellbeingUniversity of Central LancashirePrestonUK
| | - Umesh Chauhan
- School of NursingFaculty of Health & WellbeingUniversity of Central LancashirePrestonUK
- MacKenzie Chair in Primary Care MedicineUniversity of Central Lancashire; GP and CVD LeadEast Lancashire Clinical Commissioning GroupUK
| | - Josephine M. E. Gibson
- National Institute for Health Research (NIHR)Collaboration for Leadership in Applied Health Research and Care, North West Coast (CLAHRC, NWC)PrestonUK
- School of NursingFaculty of Health & WellbeingUniversity of Central LancashirePrestonUK
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Harris L, Melville C, Murray H, Hankey C. The effects of multi-component weight management interventions on weight loss in adults with intellectual disabilities and obesity: A systematic review and meta-analysis of randomised controlled trials. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 72:42-55. [PMID: 29107176 DOI: 10.1016/j.ridd.2017.10.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 10/20/2017] [Accepted: 10/21/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Adults with intellectual disabilities have been shown to experience higher rates of obesity in comparison to the general population. AIM To examine the effectiveness of randomised controlled trials of multi-component weight management interventions for adults with intellectual disabilities and overweight/obesity. METHODS AND PROCEDURES A systematic search of six electronic databases was conducted from database inception to January 2016. Risk of bias was assessed by the Cochrane Collaboration tool. Behavioural change techniques were defined by coding against the Coventry Aberdeen LOndon REfined (CALO-RE) taxonomy. Meta-analyses were conducted as Weighted Mean Difference (WMD) between intervention and control/comparator intervention. OUTCOMES AND RESULTS Six randomised controlled trials were included. The interventions did not adhere to clinical recommendations [the inclusion of an energy deficit diet (EDD), physical activity, and behaviour change techniques]. Meta-analysis revealed that current multi-component weight management interventions are not more effective than no treatment (WMD: -0.38kg; 95% CI -1.34kg to 0.58kg; p=0.44). CONCLUSION AND IMPLICATIONS There is a paucity of randomised controlled trials of multi-component weight management interventions for adults with intellectual disabilities and overweight/obesity. Current interventions, based on a health education approach are ineffective. Future long-term interventions that include an EDD and adhere to clinical recommendations on the management of obesity are warranted.
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Affiliation(s)
- Leanne Harris
- College of Medical Veterinary and Life Sciences, Institute of Mental Health & Wellbeing, University of Glasgow, Glasgow G12 0XH, UK.
| | - Craig Melville
- College of Medical Veterinary and Life Sciences, Institute of Mental Health & Wellbeing, University of Glasgow, Glasgow G12 0XH, UK.
| | - Heather Murray
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8QQ, UK.
| | - Catherine Hankey
- College of Medical Veterinary and Life Sciences, Institute of Health & Wellbeing, University of Glasgow, Glasgow G31 2ER, UK.
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Lee RLT, Leung C, Chen H, Louie LHT, Brown M, Chen JL, Cheung G, Lee PH. The Impact of a School-Based Weight Management Program Involving Parents via mHealth for Overweight and Obese Children and Adolescents with Intellectual Disability: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1178. [PMID: 28981460 PMCID: PMC5664679 DOI: 10.3390/ijerph14101178] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/24/2017] [Accepted: 09/18/2017] [Indexed: 11/20/2022]
Abstract
There is a scarcity of resources and studies that utilize targeted weight management interventions to engage parents via mHealth tools targeting obese children and adolescents with mild intellectual disabilities (MIDs) extended from school to a home setting. To test the feasibility and acceptability of a school-based weight program (SBWMP) involving parents via mHealth tools designed to reduce weight, enhance knowledge and adopt healthy lifestyles, and thereby achieve better psychosocial well-being among children and adolescents with MIDs. Four special schools were randomly assigned as intervention or control schools. Students from the intervention group (n = 63) were compared to those in the control group (n = 52), which comprised those with usual school planned activities and no parental involvement. Demographics were considered as covariates in a general linear model, an ordinal regression model and a binary logistic regression model analyzing the relationships between the SBWMP and the outcome variables at baseline (T0) and six months later (T1). Body weight, body mass index, and triceps and subscapular skinfold thickness were lower in the intervention group compared to the control group, although the differences were not statistically significant. There was a positive and direct impact of the SBWMP on students' health knowledge and psychological impacts in the intervention group. The SBWMP extended to the home involving parents via mHealth tools is a feasible and acceptable program for this group with MIDs and their parents.
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Affiliation(s)
- Regina Lai-Tong Lee
- World Health Organization Collaborating Center for Community Health Services, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Cynthia Leung
- Department of Applied & Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Hong Chen
- Infection Control Branch, Centre for Health Protection, Hong Kong, China.
| | - Lobo H T Louie
- Department of Physical Education, Hong Kong Baptist University, Hong Kong, China.
| | - Michael Brown
- School of Nursing and Midwifery, Queen's University, Belfast B79 7BL, Northern Ireland, UK.
| | - Jyu-Lin Chen
- Faculty of Nursing, University of California San Francisco, San Francisco, CA 94143, USA.
| | | | - Paul H Lee
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
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19
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A cluster randomised control trial of a multi-component weight management programme for adults with intellectual disabilities and obesity. Br J Nutr 2017; 118:229-240. [DOI: 10.1017/s0007114517001933] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AbstractThere have been few published controlled studies of multi-component weight management programmes that include an energy deficit diet (EDD), for adults with intellectual disabilities and obesity. The objective of this study was to conduct a single-blind, cluster randomised controlled trial comparing a multi-component weight management programme to a health education programme. Participants were randomised to either TAKE 5, which included an EDD or Waist Winners Too (WWToo), based on health education principles. Outcomes measured at baseline, 6 months (after a weight loss phase) and 12 months (after a 6-month weight maintenance phase), by a researcher blinded to treatment allocation, included: weight; BMI; waist circumference; physical activity; sedentary behaviour and health-related quality of life. The recruitment strategy was effective with fifty participants successfully recruited. Both programmes were acceptable to adults with intellectual disabilities, evidenced by high retention rates (90 %). Exploratory efficacy analysis revealed that at 12 months there was a trend for more participants in TAKE 5 (50·0 %) to achieve a clinically important weight loss of 5–10 %, in comparison to WWToo (20·8 %) (OR 3·76; 95 % CI 0·92, 15·30; 0·064). This study found that a multi-component weight management programme that included an EDD, is feasible and an acceptable approach to weight loss when tailored to meet the needs of adults with intellectual disabilities and obesity.
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20
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Kenshole AV, Gallichan D, Pahl S, Clibbens J. Lifestyle factors and Alzheimer's disease in people with Down syndrome. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 30 Suppl 1:58-66. [PMID: 28758309 DOI: 10.1111/jar.12369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lifestyle has previously been associated with the onset of Alzheimer's disease (AD) in the typically developing population, but research investigating this association in Down syndrome (DS) is limited. METHOD Adults with DS and AD (n = 27) were compared to adults with DS without AD (n = 30) on physical activity, diet, weight, where participants currently lived, where participants had lived for the majority of their lives, educational attainment, occupational attainment and cognitive activity. RESULTS There was a significant difference between samples on where participants currently lived, with the majority of the clinical sample living in institutionalized settings and the majority of the control sample living in independent/supported living settings. This may reflect a tendency to move people once they start to deteriorate which, if correct, is contrary to clinical recommendations that people with AD should be supported to "die in place." CONCLUSIONS Further research into the way in which lifestyle factors, particularly living environment, could contribute to the increased risk of AD in adults with DS is required. This may support interventions aimed at preventing or delaying the onset of the disease.
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Affiliation(s)
- Athena V Kenshole
- Livewell Southwest CIC, School of Psychology, University of Plymouth, UK.,Livewell Southwest CIC, Plymouth, UK
| | | | - Sabine Pahl
- School of Psychology, University of Plymouth, Plymouth, UK
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Cramm JM, Nieboer AP. Validation of an instrument to assess the delivery of patient-centred care to people with intellectual disabilities as perceived by professionals. BMC Health Serv Res 2017; 17:472. [PMID: 28693569 PMCID: PMC5504747 DOI: 10.1186/s12913-017-2424-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 06/30/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patient/Person Centred Care (PCC) has achieved widespread attention which resulted in the identification of eight dimensions of PCC: Respect for the patients' values, preferences and expressed needs; information and education; access to care; emotional support to relieve fear and anxiety; involvement of family and friends; continuity and secure transition between healthcare settings; physical comfort; coordination of care. An instrument to assess patient centeredness of care delivery according to these eight dimensions among professionals is however lacking. The main objective of this study is therefore to develop and validate an instrument to assess the eight PCC dimensions among professionals providing care to institutionalized People With Intellectual Disabilities (PWIDs). METHODS This cross-sectional survey study was conducted in a disability care centre in the region Twente in the Netherlands, the Twentse Zorgcentra. All professionals delivering care to institutionalized PWIDs (n = 1146) were invited to participate. An instrument was developed to assess the eight dimensions of PCC, which was tested among 464 professionals (response rate = 40%). We tested the instrument by means of structural equation modelling, and examined its validity and reliability. RESULTS Indices of the 35-item PCC version are satisfactory but showed that the model left room for improvement and shortening of the instrument (RMSEA >0.06 and CFI < 0.95). Confirmatory factor analyses revealed good indices of fit with the 24-item PCC-instrument among professionals. Internal consistency of the overall instrument was also good. CONCLUSIONS The psychometric properties of the 24-item PCC-instrument were satisfactory, rendering it a valid and reliable instrument for assessing the eight dimensions of PCC among professionals providing care to institutionalized PWIDs.
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Affiliation(s)
- Jane Murray Cramm
- Institute of Health Policy & Management (iBMG), Erasmus University, Rotterdam, The Netherlands
| | - Anna Petra Nieboer
- Institute of Health Policy & Management (iBMG), Erasmus University, Rotterdam, The Netherlands
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22
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Ptomey LT, Gibson CA, Lee J, Sullivan DK, Washburn RA, Gorczyca AM, Donnelly JE. Caregivers' effect on weight management in adults with intellectual and developmental disabilities. Disabil Health J 2017; 10:542-547. [PMID: 28215627 DOI: 10.1016/j.dhjo.2017.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/03/2017] [Accepted: 02/08/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Caregivers of adults with IDD often play a large role in the ability of adults with IDD to lose weight. OBJECTIVE The purpose of this study was to determine to examine the effects of the caregivers' perceived burdens and self-efficacy and their relationship to an individual (family member or paid staff) on weight changes across a weight management intervention for adults with IDD. METHODS Overweight/obese adults with mild to moderate IDD, along with assigned caregivers who served as their study partner, were randomized to an 18-month weight management intervention. The living environment and caregiver relationship were assessed at baseline. Caregivers completed questionnaires regarding perceived hassles, uplifts, and self-efficacy in helping the participant follow a weight management intervention. RESULTS 147 adults with IDD (∼57% women and ∼16% minorities) were included in data analysis. After 18 months, there were no differences in weight loss between participants who had a family member as their study partner and those who had a paid assistant as their study partner (-5.5 ± 5.2% vs. -5.6± 5.3% p = 0.16). However, paid assistants reported more hassles with following the diet intervention at 6 months (p < 0.05). Participants who had a paid assistant as their study partner were more likely to have multiple study partners during the study, which was correlated with smaller weight loss. CONCLUSION While caregivers are important for weight management of adults with IDD, the caregiver's relationship to the participant does not affect weight change in an intervention.
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Affiliation(s)
- L T Ptomey
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - C A Gibson
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - J Lee
- Institute for Measurement, Methodology, Analysis and Policy, Texas Tech University, 2500 Broadway, Lubbock, TX 79409, USA.
| | - D K Sullivan
- Department of Dietetics and Nutrition, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - R A Washburn
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - A M Gorczyca
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - J E Donnelly
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
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Brennan L, Murphy KD, de la Piedad Garcia X, Ellis ME, Metzendorf MI, McKenzie JE. Psychological interventions for adults who are overweight or obese. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Leah Brennan
- Australian Catholic University; School of Psychology; The Daniel Mannix Building, Young Street, Fitzroy Melbourne Victoria Australia 3065
| | - Kylie D Murphy
- Monash University; Centre for Obesity Research and Education; Level 6, The Alfred Centre, 99 Commercial Road Melbourne Victoria Australia 3004
| | - Xochitl de la Piedad Garcia
- Australian Catholic University; School of Psychology; The Daniel Mannix Building, Young Street, Fitzroy Melbourne Victoria Australia 3065
| | - Miriam E Ellis
- Australian Catholic University; School of Psychology; The Daniel Mannix Building, Young Street, Fitzroy Melbourne Victoria Australia 3065
| | - Maria-Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf; Cochrane Metabolic and Endocrine Disorders Group; Moorenstr. 5 Düsseldorf Germany 40225
| | - Joanne E McKenzie
- Monash University; School of Public Health & Preventive Medicine; Level 1, 549 St Kilda Road Melbourne Victoria Australia 3004
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Ptomey LT, Gibson CA, Willis EA, Taylor JM, Goetz JR, Sullivan DK, Donnelly JE. Parents' perspective on weight management interventions for adolescents with intellectual and developmental disabilities. Disabil Health J 2015; 9:162-6. [PMID: 26277410 DOI: 10.1016/j.dhjo.2015.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/28/2015] [Accepted: 07/08/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Adolescents with intellectual and developmental disabilities (IDD) have high rates of obesity. However, little research has been conducted demonstrating effective strategies and barriers for weight loss or weight management in adolescents with IDD. Furthermore, parents play a large role in terms of weight management in children and adolescents with IDD, and their views should be taken into consideration when designing a diet and PA intervention for weight management. OBJECTIVE The aims of this study are to better understand the parents' perspectives on the strategies and barriers for helping children and adolescents with IDD be successful in a weight management program and to identify how this information to guide future approaches. METHODS Semi-structured interviews were conducted in 18 parents whose children had just finished a diet and PA intervention. Interviews were transcribed verbatim, and thematic analysis was performed. RESULTS Parents reported a positive attitude toward the program, liked the convenience of the program, and felt that they learned beneficial strategies to encourage healthy habits in the home. Parents found time to be a major barrier to supporting their child with a diet and PA intervention. Parents were willing to change their own dietary behaviors to help their children successfully follow a weight loss intervention; however, no parent reported changing their own PA levels. CONCLUSION Future diet and PA studies should aim to reduce parental time commitment and increase importance of PA.
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Affiliation(s)
- Lauren T Ptomey
- Cardiovascular Research Institute, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
| | - Cheryl A Gibson
- Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Erik A Willis
- Cardiovascular Research Institute, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Jacob M Taylor
- Department of Dietetics and Nutrition, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA; Department of Nutrition Services, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108, USA
| | - Jeannine R Goetz
- Department of Dietetics and Nutrition, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Joseph E Donnelly
- Cardiovascular Research Institute, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
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Martínez-Zaragoza F, Campillo-Martínez JM, Ato-García M. Effects on Physical Health of a Multicomponent Programme for Overweight and Obesity for Adults with Intellectual Disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2015; 29:250-65. [DOI: 10.1111/jar.12177] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2014] [Indexed: 12/01/2022]
Affiliation(s)
| | | | - Manuel Ato-García
- Department of Basic Psychology and Methodology; Faculty of Psychology; University of Murcia; Murcia Spain
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Sundblom E, Bergström H, Ellinder LS. Understanding the Implementation Process of a Multi-Component Health Promotion Intervention for Adults with Intellectual Disabilities in Sweden. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2015; 28:296-306. [DOI: 10.1111/jar.12139] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Elinor Sundblom
- Centre for Epidemiology and Community Medicine; Solna Sweden
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Ptomey LT, Sullivan DK, Lee J, Goetz JR, Gibson C, Donnelly JE. The use of technology for delivering a weight loss program for adolescents with intellectual and developmental disabilities. J Acad Nutr Diet 2014; 115:112-8. [PMID: 25441960 DOI: 10.1016/j.jand.2014.08.031] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 07/29/2014] [Indexed: 11/19/2022]
Abstract
Adolescents with intellectual and developmental disabilities (IDD) are at an increased risk of obesity, with up to 55% considered overweight and 31% obese. However, there has been minimal research on weight management strategies for adolescents with IDD. The purpose of this study was to compare the effectiveness of two weight loss diets, an enhanced Stop Light Diet (eSLD) and a conventional diet (CD), and to determine the feasibility of using tablet computers as a weight loss tool in overweight and obese adolescents with IDD. A 2-month pilot intervention was conducted. All participants were randomized to the eSLD or CD and were given a tablet computer that they used to track daily dietary intake and physical activity. Participants and parents met weekly with a registered dietitian nutritionist via video chat on the tablet computer to receive diet and physical activity feedback and education. Twenty participants (45% female, aged 14.9±2.2 years) were randomized and completed the intervention. Participants in both diets were able to lose weight, and there were no significant differences between the eSLD and CD (-3.89±2.66 kg vs -2.22±1.37 kg). Participants were able to use the tablet computer to track their dietary intake 83.4%±21.3% of possible days and to attend 80.0% of the video chat meetings. Both dietary interventions appear to promote weight loss in adolescents with IDD, and the use of tablet computers appears to be a feasible tool to deliver a weight loss intervention in adolescents with IDD.
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Bennett AE, Cunningham C. A qualitative evaluation of a healthy cookery course in Ireland designed for adults with mild to moderate intellectual disability. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2014; 18:270-281. [PMID: 25099009 DOI: 10.1177/1744629514544074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Adults with an intellectual disability have poorer diets than the general adult population. The Able 2 Cook 4 Health cookery course aims to improve the diets of adults with mild to moderate intellectual disability. This study aims to evaluate the course by obtaining the views of course participants and the views of managers hosting the course. Thirty course participants took part in focus groups. Five managers hosting the course participated in a semi-structured interview. Positive features of the course included the group cooking, social interaction and course instructors. Collaboration between centres hosting the course and participants' home environment is needed to help transfer the skills learned to all home settings. The Able 2 Cook 4 Health cookery course provided participants with an important social outlet to learn essential occupational skills. These findings could particularly influence the diets of adults with an intellectual disability moving into independent living.
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Maïano C, Normand CL, Aimé A, Bégarie J. Lifestyle interventions targeting changes in body weight and composition among youth with an intellectual disability: A systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:1914-1926. [PMID: 24830882 DOI: 10.1016/j.ridd.2014.04.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 04/07/2014] [Accepted: 04/08/2014] [Indexed: 06/03/2023]
Abstract
Over the past three decades, the potential effects of lifestyle interventions targeting changes in body weight and composition (weight, body mass index, fat mass, waist circumference) among adults with an intellectual disability (ID) have been examined in various systematic reviews. Nevertheless, since the middle of the 1980s, the potential effects of these interventions for youth with an ID remain an open question. The purpose of this article is to review the effects of lifestyle interventions targeting changes in body weight and composition among youth with an ID. This review will focus on changes in body weight and composition, healthy lifestyle, and secondary health conditions. A systematic review of English- and French-language studies, published between 1981 and 2013, was performed on Academic Search Complete, PsycARTICLES, Medline and Scopus. The nine studies included in this review focused mainly on: a sample with a wide age range (e.g., 7-22 years); males; overweight-obese youth having a mild-to-moderate ID with Down or Prader-Willi syndrome; physical activity interventions; cohort pre- and post-test designs with/without a control group; and changes in body weight and composition. Taken together, results from these studies suggest successful changes in weight, body mass index and fat mass. However, intervention effects on healthy lifestyle and secondary health conditions are scarce and inconclusive. Given the weaknesses of the reviewed studies, the present findings should be considered preliminary and indicative of the need for future research.
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Affiliation(s)
- Christophe Maïano
- Cyberpsychology Laboratory, Department of Psychoeducation and Psychology, Université du Québec en Outaouais (UQO), Canada.
| | - Claude L Normand
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais (UQO), Canada
| | - Annie Aimé
- Cyberpsychology Laboratory, Department of Psychoeducation and Psychology, Université du Québec en Outaouais (UQO), Canada
| | - Jérôme Bégarie
- Croix-Rouge française, Complexe de L'Escarène, 06440 L'Escarène, France
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Bergström H, Elinder LS, Wihlman U. Barriers and facilitators in health education for adults with intellectual disabilities--a qualitative study. HEALTH EDUCATION RESEARCH 2014; 29:259-271. [PMID: 24399263 DOI: 10.1093/her/cyt111] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The aim of this study was to explore barriers and facilitators in the implementation of a health course for adults with mild or moderate intellectual disabilities. An inductive qualitative design was used. Data were collected from a health course conducted in 16 study groups with 83 participants in Stockholm, Sweden by unstructured observations in course sessions, a group discussion with course leaders and evaluation notes from the course leaders. The data were analysed by qualitative content analysis. Four categories were identified: (i) 'individual characteristics', implying various needs, (ii) 'pedagogical strategies' used to meet those needs, (iii) 'interaction within the course', dealing with active and less active participation and (iv) 'structures', including learning climate and organizing. The overarching theme 'creating an individualized supportive context' describes the challenge of educating people with intellectual disabilities towards an empowered and well informed decision making regarding their own health. Therefore, there is a need for support not only within the course but also from the social and physical environment as well.
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Affiliation(s)
- H Bergström
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 141 83 Huddinge, Sweden, Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden and Independent Researcher, Stockholm, Sweden
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Impact of a Smarter Lunchroom intervention on food selection and consumption among adolescents and young adults with intellectual and developmental disabilities in a residential school setting. Public Health Nutr 2014; 18:361-71. [PMID: 24636533 DOI: 10.1017/s1368980014000305] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess whether a Smarter Lunchroom intervention based on behavioural economics and adapted for students with intellectual and developmental disabilities would increase the selection and consumption of fruits, vegetables and whole grains, and reduce the selection and consumption of refined grains. DESIGN The 3-month intervention took place at a residential school between March and June 2012. The evaluation employed a quasi-experimental, pre-post design comparing five matched days of dietary data. Selection and plate waste of foods at lunch were assessed using digital photography. Consumption was estimated from plate waste. SETTING Massachusetts, USA. SUBJECTS Students (n 43) aged 11-22 years with intellectual and developmental disabilities attending a residential school. RESULTS Daily selection of whole grains increased by a mean of 0·44 servings (baseline 1·62 servings, P = 0·005) and refined grains decreased by a mean of 0·33 servings (baseline 0·82 servings, P = 0·005). The daily consumption of fruits increased by a mean of 0·18 servings (baseline 0·39 servings, P = 0·008), whole grains increased by 0·38 servings (baseline 1·44 servings, P = 0·008) and refined grains decreased by a mean of 0·31 servings (baseline 0·68 servings, P = 0·004). Total kilojoules and total gram weight of food selected and consumed were unchanged. Fruit (P = 0·04) and vegetable (P = 0·03) plate waste decreased. CONCLUSIONS A Smarter Lunchroom intervention significantly increased whole grain selection and consumption, reduced refined grain selection and consumption, increased fruit consumption, and reduced fruit and vegetable plate waste. Nudge approaches may be effective for improving the food selection and consumption habits of adolescents and young adults with intellectual and developmental disabilities.
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Ptomey L, Goetz J, Lee J, Donnelly J, Sullivan D. Diet Quality of Overweight and Obese Adults with Intellectual and Developmental Disabilities as Measured by the Healthy Eating Index-2005. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2013; 25:10.1007/s10882-013-9339-z. [PMID: 24319322 PMCID: PMC3848605 DOI: 10.1007/s10882-013-9339-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Little research has been conducted to examine diet quality of overweight and obese adults with intellectual and developmental disabilities (IDD) in the United States. The purpose of this study was to determine diet quality, as measured by the Healthy Eating Index-2005 (HEI-2005), of overweight and obese adults with IDD. METHODS Data were obtained from community-dwelling overweight individuals. 3-day food records were administered and completed with assistance by staff or family members and then reviewed by a dietitian. All records were analyzed and HEI-2005 was calculated using NDSR output. RESULTS 178 records were analyzed from 70 subjects (28 male, 42 female; mean age 33.9 ±11.5 years). The mean energy intake was 1928 ± 891 kcals and the mean total HEI-2005 score was 46.7± 11.5. Participants scored the lowest in total fruits, whole grains, dark green and orange vegetables, non-hydrogenated vegetable oils, and sodium. Both male and females had diets deficient in fiber, vitamin A, vitamin D, vitamin E, folate, and potassium. Additionally men were deficient in vitamin K, and women were deficient in calcium. CONCLUSIONS Overweight and Obese adults with IDD had a lower HEI-2005 score compared to the general population and are at an increased risk of poor diet quality and nutritional deficiencies that could contribute to the development of diabetes, cardiovascular disease, cancer and other health complications.
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Affiliation(s)
- Lauren Ptomey
- Department of Dietetics and Nutrition, Center for Physical Activity and Weight Management, University of Kansas Medical Center, 3901 Rainbow Boulevard; MS 4013; Kansas City, KS 66160, Phone Number: 913-945-8182, Fax Number: 913-588-8946
| | - Jeannine Goetz
- Department of Dietetics and Nutrition, University of Kansas Medical Center, 3901 Rainbow Boulevard; MS 4013; Kansas City, KS 66160
| | - Jaehoon Lee
- , 1425 Jayhawk Boulevard; Lawrence, KS 66045-7547. Center for Research Methods and Data Analysis, University of Kansas, Lawrence, KS 66045, Phone Number: 785-550-7098, Fax Number: 785-864-2009
| | - Joseph Donnelly
- Department of Internal Medicine, Cardiovascular Research Institute, Center for Physical Activity and Weight Management, University of Kansas Medical Center, 1301 Sunnyside Ave; Robinson Room 100; Lawrence, KS 66045
| | - Debra Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, 3901 Rainbow Boulevard; MS 4013; Kansas City, KS 66160
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Curtin C, Bandini LG, Must A, Gleason J, Lividini K, Phillips S, Eliasziw M, Maslin M, Fleming RK. Parent support improves weight loss in adolescents and young adults with Down syndrome. J Pediatr 2013; 163:1402-8.e1. [PMID: 23968742 PMCID: PMC3812279 DOI: 10.1016/j.jpeds.2013.06.081] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 04/23/2013] [Accepted: 06/28/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess whether parent training in behavioral intervention, combined with a 16-session nutrition and activity education program, would improve weight loss relative to nutrition and activity education alone in adolescents and young adults with Down syndrome. STUDY DESIGN Twenty-one patients with Down syndrome aged 13-26 years with a body mass index ≥ 85 th percentile were enrolled and randomized to a 6-month nutrition and activity education intervention (n = 10) or to a nutrition and activity education+behaviorial intervention (n = 11), and followed for 6 months after the active intervention period (1-year follow-up). The primary outcome measure was body weight; secondary outcomes included percentage body fat by bioelectric impedance; intake of fruits, vegetables, and energy-dense low-nutrient snack food (treats) by 3-day food record; and moderate/vigorous physical activity by accelerometry. RESULTS At 6 months, mean body weight in the nutrition and activity education+behavioral intervention group was 3.2 kg lower than that in the nutrition and activity education group (95% CI, 1.0-5.5 kg; P = .005). Mean group differences were sustained at 1 year (3.6 kg; 95% CI, 1.4-5.9 kg; P = .002). At 6 months, moderate/vigorous physical activity time increased by an average of 18 minutes/day compared with baseline in the nutrition and activity education+behavioral intervention group (P = .01) and decreased by 7 minutes/day in the nutrition and activity education group (P = .30). These changes were largely maintained at 1 year, but were not statistically significant. Vegetable intake in the nutrition and activity education+behavioral intervention group exceeded that in the nutrition and activity education group by a mean of 1.6 servings at 1 year (P = .009), but not at 6 months. No between-group differences were observed for percentage body fat or consumption of fruits or treats. CONCLUSION Parent-supported behavioral intervention appears to be a successful adjunct to a 6-month nutrition education intervention in achieving weight loss in adolescents and young adults with Down syndrome.
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Affiliation(s)
- Carol Curtin
- Eunice Kennedy Shriver Center, University of Massachusetts Medical School, Waltham, MA.
| | - Linda G. Bandini
- University of Massachusetts Medical School/E.K. Shriver Center, Waltham, MA
,Department of Health Sciences, Boston University, Boston, MA
| | - Aviva Must
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA
| | - James Gleason
- University of Massachusetts Medical School/E.K. Shriver Center, Waltham, MA
| | - Keith Lividini
- Harvest Plus, International Food Policy Research Institute, Washington, DC
| | - Sarah Phillips
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA
| | - Misha Eliasziw
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA
| | - Melissa Maslin
- University of Massachusetts Medical School/E.K. Shriver Center, Waltham, MA
| | - Richard K. Fleming
- Department of Exercise and Health Sciences, University of Massachusetts Boston
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Bergström H, Hagströmer M, Hagberg J, Elinder LS. A multi-component universal intervention to improve diet and physical activity among adults with intellectual disabilities in community residences: a cluster randomised controlled trial. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:3847-3857. [PMID: 24021393 DOI: 10.1016/j.ridd.2013.07.019] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 07/10/2013] [Accepted: 07/10/2013] [Indexed: 06/02/2023]
Abstract
People with ID have an increased risk for unhealthy diets, physical inactivity and weight disturbances. The aim of the current study was to investigate the effectiveness of a novel and complex intervention to improve diet and physical activity, targeting both caregivers and residents, in community residences for people with ID. A three component intervention based on Social Cognitive Theory was developed, including: (1) appointment of a health ambassador in each community residence attending network meetings, (2) a study circle for caregivers, and (3) a health course for the residents. The intervention lasted for 12-16 months and allowed for some local tailoring. A cluster randomised controlled trial, randomised at residence level, was conducted to evaluate the effects of the intervention. Thirty community residences for people with mild or moderate ID in Stockholm County, Sweden, were included. A total of 130 participants, 74 women and 56 men aged 20-66 years, entered, and 129 participants completed the study. The primary outcome was physical activity, measured by pedometry. Secondary outcomes were BMI, waist circumference, dietary quality measured by digital photography, satisfaction with life assessed with a scale, and work routines assessed with a questionnaire. Outcomes were related to intervention fidelity. A positive intervention effect was found on physical activity, with an average increase of 1608 steps/day among participants in the intervention group (P=0.045). The effect size was 0.29 (Cohen's d). The type of residence was found to be an effect moderator. A positive intervention effect was found as well on work routines, with an average increase of 7.1 percentage points on a self-assessment scale among residences in the intervention group (P=0.016). No significant effects were found on BMI, waist circumference, dietary quality, or satisfaction with life. In conclusion, this innovative intervention was effective in improving physical activity and work routines. It is likely that even greater effects could be achieved by improvements in implementation strategies, leading to higher fidelity.
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Affiliation(s)
- Helena Bergström
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels allé 3, 141 83 Huddinge, Sweden; Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 1497, 171 29 Solna, Sweden.
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Spanos D, Melville CA, Hankey CR. Weight management interventions in adults with intellectual disabilities and obesity: a systematic review of the evidence. Nutr J 2013; 12:132. [PMID: 24060348 PMCID: PMC3849062 DOI: 10.1186/1475-2891-12-132] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 09/10/2013] [Indexed: 11/16/2022] Open
Abstract
To evaluate the clinical effectiveness of weight management interventions in adults with intellectual disabilities (ID) and obesity using recommendations from current clinical guidelines for the first line management of obesity in adults. Full papers on lifestyle modification interventions published between 1982 to 2011 were sought by searching the Medline, Embase, PsycINFO and CINAHL databases. Studies were evaluated based on (1) intervention components, (2) methodology, (3) attrition rate (4) reported weight loss and (5) duration of follow up. Twenty two studies met the inclusion criteria. The interventions were classified according to inclusion of the following components: behaviour change alone, behaviour change plus physical activity, dietary advice or physical activity alone, dietary plus physical activity advice and multi-component (all three components). The majority of the studies had the same methodological limitations: no sample size justification, small heterogeneous samples, no information on randomisation methodologies. Eight studies were classified as multi-component interventions, of which one study used a 600 kilocalorie (2510 kilojoule) daily energy deficit diet. Study durations were mostly below the duration recommended in clinical guidelines and varied widely. No study included an exercise program promoting 225-300 minutes or more of moderate intensity physical activity per week but the majority of the studies used the same behaviour change techniques. Three studies reported clinically significant weight loss (≥ 5%) at six months post intervention. Current data indicate weight management interventions in those with ID differ from recommended practice and further studies to examine the effectiveness of multi-component weight management interventions for adults with ID and obesity are justified.
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Affiliation(s)
- Dimitrios Spanos
- College of Medical, Veterinary and Medical and Life Sciences, University of Glasgow, Glasgow G31 2ER, UK
- Learning Disabilities Psychiatry, College of Medical Veterinary and Life Sciences, Institute of Mental Health & Wellbeing, University of Glasgow, Glasgow G12 0XH, UK
| | - Craig Andrew Melville
- Learning Disabilities Psychiatry, College of Medical Veterinary and Life Sciences, Institute of Mental Health & Wellbeing, University of Glasgow, Glasgow G12 0XH, UK
| | - Catherine Ruth Hankey
- Human Nutrition, College of Medical, Veterinary and Medical and Life Sciences, University of Glasgow, Glasgow Royal Infirmary, Level 2, New Lister Building, Glasgow G31 2ER, UK
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Spanos D, Hankey C, Boyle S, Melville C. Comparing the effectiveness of a multi‐component weight loss intervention in adults with and without intellectual disabilities. J Hum Nutr Diet 2013; 27:22-9. [DOI: 10.1111/jhn.12051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- D. Spanos
- College of Medical Veterinary and Life Sciences University of Glasgow Glasgow UK
| | - C. Hankey
- College of Medical Veterinary and Life Sciences University of Glasgow Glasgow UK
| | - S. Boyle
- Glasgow and Clyde Weight Management Service NHS Greater Glasgow and Clyde Glasgow UK
| | - C. Melville
- College of Medical Veterinary and Life Sciences University of Glasgow Glasgow UK
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Beeken RJ, Spanos D, Fovargue S, Hunter R, Omar R, Hassiotis A, King M, Wardle J, Croker H. Piloting a manualised weight management programme (Shape Up-LD) for overweight and obese persons with mild-moderate learning disabilities: study protocol for a pilot randomised controlled trial. Trials 2013; 14:71. [PMID: 23497560 PMCID: PMC3605362 DOI: 10.1186/1745-6215-14-71] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 02/26/2013] [Indexed: 01/22/2023] Open
Abstract
Background National obesity rates have dramatically risen over the last decade. Being obese significantly reduces life expectancy, increases the risk of a range of diseases, and compromises quality of life. Costs to both the National Health Service and society are high. An increased prevalence of obesity in people with learning disabilities has been demonstrated. The consequences of obesity are particularly relevant to people with learning disabilities who are already confronted by health and social inequalities. In order to provide healthcare for all, and ensure equality of treatment for people with learning disabilities, services must be developed specifically with this population in mind. The aim of this project is to pilot the evaluation of a manualised weight management programme for overweight and obese persons with mild-moderate learning disabilities (Shape Up-LD). Methods/Design An individually randomised, controlled pilot trial in 60 overweight and obese (body mass index ≥ 25) adults (age ≥ 18) with mild-moderate learning disabilities and their carers will be carried out, comparing “Shape Up-LD” with usual care. The manualised Shape Up-LD intervention will involve 12 weekly sessions, which include healthy eating messages, advice on physical activity and use of behaviour change techniques to help people manage their weight. Assessments of participants will be conducted at baseline, 12 weeks and 6 months. Service users and their carers and service providers will also give their perspectives on the experience of Shape Up-LD in qualitative interviews at 12 weeks. Feasibility outcomes will include recruitment rates, loss to follow-up, compliance rates, completion rates, collection of information for a cost-effectiveness analysis and an estimation of the treatment effect on weight. Discussion The findings from this study will inform our preparation for a definitive randomised controlled trial to test the efficacy of the programme with respect to weight loss and maintenance in this population. Weight loss through Shape Up-LD could lead to improvements in health and quality of life. Costs to the National Health Service might be reduced through decreased overall service use because of improved health. The programme would also ensure a more equitable service for overweight service users with learning disabilities and fill the current gap in weight management services for this population. Trial registration International Standard Randomised Controlled Trial No ISRCTN39605930
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Affiliation(s)
- Rebecca J Beeken
- Department of Epidemiology & Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
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Casey AF, Rasmussen R. Reduction measures and percent body fat in individuals with intellectual disabilities: A scoping review. Disabil Health J 2013; 6:2-7. [DOI: 10.1016/j.dhjo.2012.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 09/04/2012] [Accepted: 09/21/2012] [Indexed: 01/29/2023]
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Spanos D, Hankey CR, Boyle S, Koshy P, Macmillan S, Matthews L, Miller S, Penpraze V, Pert C, Robinson N, Melville CA. Carers' perspectives of a weight loss intervention for adults with intellectual disabilities and obesity: a qualitative study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2013; 57:90-102. [PMID: 22369631 DOI: 10.1111/j.1365-2788.2011.01530.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND To date, no studies have explored the role of carers in supporting adults with intellectual disabilities (ID) and obesity during a weight loss intervention. The present study explored perceptions of carers supporting adults with ID, as they participated in a 6-month multi-component weight loss intervention (TAKE 5). METHODS Semi-structured interviews were used to explore the experiences of 24 carers. The transcripts were analysed qualitatively using thematic analysis. RESULTS Three themes emerged from the analysis: carers' perceptions of participants' health; barriers and facilitators to weight loss; and carers' perceptions of the weight loss intervention. Data analysis showed similarities between the experiences reported by the carers who supported participants who lost weight and participants who did not. Lack of sufficient support from people from the internal and external environment of individuals with ID and poor communication among carers, were identified as being barriers to change. The need for accessible resources tailored to aid weight loss among adults with ID was also highlighted. CONCLUSION This study identified specific facilitators and barriers experienced by carers during the process of supporting obese adults with ID to lose weight. Future research could utilise these findings to inform appropriate and effective weight management interventions for individuals with ID.
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Affiliation(s)
- D Spanos
- Institute of Health and Wellbeing, College of Medical and Veterinary Life Sciences, University of Glasgow, UK
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Young AF, Naji S, Kroll T. Support for self-management of cardiovascular disease by people with learning disabilities. Fam Pract 2012; 29:467-75. [PMID: 22071441 DOI: 10.1093/fampra/cmr106] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the second most common cause of death among people with learning disabilities (LD), and lifestyle has been linked to risk factors. With a shift towards illness prevention and self-management support, it is important to know how people with LD can be involved in this process. OBJECTIVE To elicit the perceptions of people with LD, carers and health professionals regarding supported self-management of CVD. METHODS A qualitative approach used in-depth semi-structured interviews based on vignettes with accompanying pictures. Fourteen people with LD, 11 carers/care staff and 11 health professionals were recruited and interviewed. Thematic framework analysis was used to analyse interview data. RESULTS In total, 11 men and 25 women were interviewed. All respondents contributed views of self-management with a wide range of opinions expressed within each participant group. Four key themes encompassed: strategies for self-management; understanding the prerequisites for self-management support; preferred supporters and challenges for self-management implementation. Facilitated service user involvement in self-management decision making was highly valued in all groups. Service users wished for co-ordinated incremental support from across agencies and individuals. CONCLUSIONS People with LD can be effectively consulted regarding health management and their views can inform service development. Promoting joined-up support across health and social care and families will require investment in resources, education and dismantling of professional barriers.
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Affiliation(s)
- Anita F Young
- Alliance for Self Care Research, Faculty of Health&Social Care, Robert Gordon University, Garthdee Road, Aberdeen AB10 7QG, UK.
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Doody CM, Doody O. Health promotion for people with intellectual disability and obesity. ACTA ACUST UNITED AC 2012; 21:460, 462-5. [DOI: 10.12968/bjon.2012.21.8.460] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Owen Doody
- Intellectual Disability Nursing, Department of Nursing and Midwifery, University of Limerick, Ireland
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Franssen JJL, Maaskant MA, van Schrojenstein Lantman-de Valk HMJ. Qualitative Study of Malnutrition in People With Intellectual Disabilities. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2011. [DOI: 10.1111/j.1741-1130.2011.00324.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Obesity and disability: time to act. Am J Prev Med 2011; 41:541-5. [PMID: 22011427 PMCID: PMC3198028 DOI: 10.1016/j.amepre.2011.07.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 05/27/2011] [Accepted: 07/12/2011] [Indexed: 11/21/2022]
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Spendelow JS. Assessment of Behavioral and Psychiatric Problems in People With Prader–Willi Syndrome: A Review of the Literature. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2011. [DOI: 10.1111/j.1741-1130.2011.00296.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jenkins CM, McKenzie K. The Application of the Theory of Planned Behaviour to Diet in Carers of People with an Intellectual Disability. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2011. [DOI: 10.1111/j.1468-3148.2010.00594.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Saunders RR, Saunders MD, Donnelly JE, Smith BK, Sullivan DK, Guilford B, Rondon MF. Evaluation of an approach to weight loss in adults with intellectual or developmental disabilities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2011; 49:103-112. [PMID: 21446873 DOI: 10.1352/1934-9556-49.2.103] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Of 79 overweight adults with intellectual or developmental disabilities who participated in a weight loss intervention, 73 completed the 6-month diet phase. The emphasis in the intervention was consumption of high volume, low calorie foods and beverages, including meal-replacement shakes. Lower calorie frozen entrees were recommended to control portion size. A walking activity was encouraged. Participants attended monthly meetings in which a small amount of cash was exchanged for self-recorded intake and exercise records completed on picture-based forms. Average weight loss was 13.2 pounds (6.3%) of baseline weight at 6 months, with weight loss shown by 64 of the 73 individuals enrolled. Those completing a 6-month follow-up phase showed weight loss of 9.4% of baseline. Increased choice and control are discussed as possible contributors to individual success.
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An open study of the effectiveness of a multi-component weight-loss intervention for adults with intellectual disabilities and obesity. Br J Nutr 2011; 105:1553-62. [DOI: 10.1017/s0007114510005362] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Adults with intellectual disabilities experience high rates of obesity. Despite this higher risk, there is little evidence on the effectiveness of weight-loss interventions for adults with intellectual disabilities and obesity. The present study examined the effectiveness of the TAKE 5 multi-component weight-loss intervention. Adults with obesity were invited using specialist intellectual disability services to participate in the study. Obesity was defined as a BMI of 30 kg/m2 or greater. TAKE 5 included a daily energy-deficit diet of 2510 kJ (600 kcal), achieved via a personalised dietary prescription. Participants' body weight, BMI, waist circumference and levels of physical activity and sedentary behaviour were measured before and after the intervention. A total of fifty-four individuals consented to participate, of which forty-seven (87 %) completed the intervention in the study period. There was a significant decrease in body weight (mean difference − 4·47 (95 % CI − 5·91, − 3·03) kg; P < 0·0001), BMI ( − 1·82 (95 % CI − 2·36, − 1·29) kg/m2; P < 0·0001), waist circumference ( − 6·29 (95 % CI − 7·85, − 4·73) cm; P < 0·0001) and daily sedentary behaviour of participants ( − 41·40 (95 % CI − 62·45, − 20·35) min; P = 0·00 034). Of the participants who completed the intervention, seventeen (36·2 %) lost 5 % or more of their initial body weight. Findings from the study suggest that TAKE 5 is an effective weight-loss intervention for adults with intellectual disabilities and obesity. The effectiveness of TAKE 5 should be examined further in a controlled study.
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Thomas GR, Kerr MP. Longitudinal Follow-up of Weight Change in the Context of a Community-Based Health Promotion Programme for Adults with an Intellectual Disability. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2011. [DOI: 10.1111/j.1468-3148.2010.00611.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Carers' perspectives on a weight loss intervention for obese adults with intellectual disabilities: a qualitative study. Proc Nutr Soc 2011. [DOI: 10.1017/s0029665111000358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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