Effects of Physical Activity on the Physical and Psychosocial Health of Youth With Intellectual Disabilities: A Systematic Review and Meta-Analysis

Mechanisms Linking Physical Activity With Mental Health in Children and Adolescents With Neurodevelopmental Disorders: A Systematic Review

INTRODUCTION

Physical activity (PA) is a promising way to improve mental health in children and adolescents with neurodevelopmental disorders (NDDs). However, the underlying mechanisms remain unclear. The current review aimed to explore the potential neurobiological, psychosocial, and behavioral mechanisms between PA interventions and mental health in children and adolescents with NDDs.

METHODS

Web of Science, PsycINFO, SPORTDiscus, MEDLINE, CINAHL, and ERIC were searched from inception to June 2023. Randomized controlled trials/quasi-experimental designs applying PA interventions and reporting at least one mental health outcome and at least one potential mechanism in children and adolescents with NDDs were included. The best evidence synthesis rating system was adopted to determine the strength and consistency of potential mechanisms and was performed in 2024.

RESULTS

In total, 45 studies were included, 29 of which were randomized controlled trials and 16 were quasi-experimental, with a total of 1,751 participants. According to the best evidence synthesis rating system, neurobiological (theta activity and P3 amplitude), psychosocial (social skills and social participation), and behavioral (motor skills and sleep) mechanisms were the frequently examined and consistent mechanisms through which PA affected mental health in children and adolescents with NDDs. However, evidence regarding P3 latency, beta activity, and physical self-concept was insufficient.

DISCUSSION

Future PA interventions could consider neurobiological (theta activity and P3 amplitude), psychosocial (social skills and social participation), and behavioral (motor skills and sleep) mechanisms. Alternatively, PA can be developed as an adjunctive approach with interventions that specifically focus on these mechanisms to enhance mental health in children and adolescents with NDDs.

Injury Risk Analysis among Judo Athletes with Intellectual Disabilities

The main aim of this study was to evaluate injury prevalence, incidence rate, and burden in judo athletes with intellectual disabilities (ID) who participate in international competitions. This retrospective cross-sectional study analyzed data from the past year for 182 judo athletes with ID. Data was collected using a self-reported questionnaire, adapted from previous research, that included questions about injuries impacting training or competition, injury type, mechanism, severity, diagnosis, and location on the body. The injury prevalence among judo athletes with ID occurred most often during training (68.2%) and primarily affected the lower extremities (35%). Age group and injury prevalence were significantly related (χ2=7.91; P=0.04), while gender, weight, and ability level were not. Results were closer to those previously reported for conventional judo, which is likely due to the lower practice intensity among judo athletes with ID. Injury prevalence was lower than in prior studies, but the incidence rates aligned when considering training time in judo athletes with ID. Injury burden analysis revealed that females had a lower burden than males, while older athletes experienced a higher burden than younger athletes. Most injuries occur during training, which is likely attributable to safety-focused competition rules.

Contribution of static and dynamic balance skills to activities of daily living in children with intellectual disabilities

BACKGROUND

Static and dynamic balance skills can be related to the activities of daily living (ADL) in children with non-syndromic intellectual disabilities, and the type of balance skills affecting ADL can differ depending on the domain of ADL (self-care, mobility, and social function).

METHODS

The ADL capabilities of 66 children with intellectual disabilities were assessed using the Pediatric Evaluation of Disability Inventory (PEDI) and were examined in relation to static and dynamic balance skills.

RESULTS

Significant positive correlations were found between the one-leg standing and PEDI (r = .841 for self-care, r = .700 for mobility, and r = .760 for social function). Our analysis showed that static balance skills affected self-care, dynamic balance skills affected mobility, and intelligence quotient affected social function.

CONCLUSIONS

Improving balance skills is important for enhancing ADL capabilities, and the type of balance skills that need enhancement vary based on the domain of ADL.

Making physical activity fun and accessible to adults with intellectual disabilities: A pilot study of a gamification intervention

BACKGROUND

Only about 9% of individuals with intellectual disabilities reach the government's physical activity (PA) recommendations. Combining gamification and technology seems particularly promising in overcoming personal and environmental barriers to PA participation.

METHOD

Eighteen adults with varying levels of intellectual disabilities completed a pilot study to assess the initial effects of a cycling gamification intervention on levels of PA, fitness, psychosocial outcomes, and challenging behaviours. The study comprised three designs: pre-post single group, AB single-case, and qualitative. Social validity, implementation barriers and facilitators were also explored.

RESULTS

Nearly all 18 participants cycled daily. Time and distance cycled daily increase during the intervention while a decrease in stereotyped behaviours was observed. Participants and staff found the intervention enjoyable and socially valid.

CONCLUSIONS

Results of the multiple-design study suggest that gamification interventions may be a suitable, enjoyable, and promising way to contribute to PA participation of adults with intellectual disabilities.

Safeguarding strategies in athletes with intellectual disabilities: A narrative review

Compared to their non-disabled peers, athletes with disabilities are at an increased risk of interpersonal violence in sport. Athletes with intellectual disabilities specifically may face compounded risk due to impaired communication and social challenges. Despite the inherent risk of interpersonal violence in athletes with intellectual disabilities, there is a paucity of literature focused on safeguarding strategies in this population, and no global consensus prevention guidelines exist. The goal of this review was to synthesize the literature on interpersonal violence in athletes with intellectual disabilities and propose an evidence-informed safeguarding framework. Future research and practice should emphasize tailored training on appropriate athlete-protection strategies and ways to recognize and respond to suspicions of abuse in this population. Given the benefits of sports participation for persons with intellectual disabilities, implementation of fit-for-purpose safeguarding strategies would help address any elevated risk of interpersonal violence. Formal monitoring and evaluation of these initiatives can help minimize interpersonal violence.

Psychosocial interventions for childhood cancer survivors: Systematic review and meta-analysis of randomized control trials

PURPOSE

This study was aimed to review and analyze the evidence of the psychosocial interventions for survivors of childhood cancer.

METHODS

Electronic databases (PubMed, Embase, Medline, Web of Science, Science Direct, and Scopus) and manuel search were performed for psychosocial randomised controlled trials (RCTs) conducted with survivors who were diagnosed under the age of 18 and have completed treatment. Meta-analyses were performed to evaluate the effects of interventions on psychosocial health outcomes. The trials were published in English between 1 January 2000 to 30 June 2022 were included. Extracted data were analyzed using Review Manager 5.4.

RESULTS

Ten trials conducted with 955 childhood cancer survivors were included in the systematic review. Meta-analysis of six RCTs showed no difference in the general quality of life (SMD, 0.07; 95% CI: [-0.09 to 0.23], I2 0%, (p > 0.05)) and three RCTs showed no difference in the physical activity self-efficacy (SMD, 0.12; 95% CI: [-0.35 to 0.58], I2 75%, (p > 0.05)) between intervention and control group. Interventions longer than 24 weeks (including follow-up) were effective in the quality of life and physical activity self-efficacy of the survivors. The overall quality of the evidence was low due to overall low risk of bias for only half of the studies (50%).

CONCLUSIONS

Psychosocial interventions were not effective on quality of life and physical activity self-efficacy of childhood cancer survivors, however, long-term interventions provided improvement in these outcomes.

REGISTRATION

The protocol for the meta-analysis was registered at PROSPERO (CRD42022375053/22 Nov 2022).

Integrated Physiotherapeutic Intervention for Rehabilitation of a Patient With Intellectual Disabilities: A Case Report

Intellectual disabilities (ID) encompass a broad spectrum of neurodevelopmental disorders marked by impairments in cognitive functioning and adaptive behavior. Accessing and benefiting from rehabilitation services pose significant challenges for individuals within this population. In this case study, the rehabilitation journey of a 44-year-old man with ID, emphasizes the tailored approach to his rehabilitation program. The primary objectives of the program were to augment the patient's functional capabilities, foster independence, and enhance his overall quality of life. The case highlights the significance of personalized, comprehensive rehabilitation strategies intricately tailored to address the distinct requirements of individuals with ID. The case study delineates a comprehensive rehabilitation regimen integrating physical therapy to address the multifaceted needs of individuals with varying degrees of disability. This inclusive approach represents a paradigm shift toward a multidisciplinary (physiotherapy along with general medical care, special education, vocational training, and community-based interventions) person-centered model of care. Through addressing the varied needs of individuals with ID, the rehabilitation plan endeavors to empower them to lead enriching, self-directed lives within their communities, thereby unlocking their complete potential. This case study stands as evidence of the profound impact of customized rehabilitation interventions in cultivating inclusivity and optimizing the well-being of individuals with ID.

Effects of exercise training programs on motor skills of individuals with intellectual disabilities: a systematic review and meta-analysis

PURPOSE

Motor skills are involved in many physical activities and are prerequisites for the performance of sport skills. The purpose of this systematic review was to examine the effects of exercise training programs (ETP) on the motor skills of individuals with intellectual disabilities (IwID).

METHODS

Primary sources were obtained from four databases including PubMed, SCOPUS, CENTRAL, and Web of Science. The search period covered years from inception to October 26th, 2023. Inclusion criteria were as follows: Population: IwID; Intervention: ETP; Comparator: motor skills vs. nontraining control; Outcomes: motor skills outcomes. Standardized mean differences, weighted mean differences, and 95% confidence intervals (CI) were calculated using both random and fixed-effect models for outcomes.

RESULTS

A total of 14 studies involving 586 participants were included in the systematic review. The results of the present meta-analysis showed that ETP improved composite motor skills (1.28 95% CI: [0.86, 1.70], p = 0.001), gross motor skills (0.91, 95% CI: [0.62,1.19], p = 0.001), fine motor skills (0.74, 95% CI: [0.21,1.27], p = 0.01) and fine-gross motor skills (0.64, 95% CI: [0.29, 1.00], p = 0.001).

CONCLUSION

The results meta-analysis demonstrated that ETP improves the motor skills of IwID. Therefore, it is recommended to apply ETP to improve the motor skills of the IwID.

Unravelling the link between physical activity and peer social connectedness in young people with intellectual disabilities: a systematic review of quantitative studies

BACKGROUND

There is limited understanding of the context surrounding physical activity (PA) of young people with intellectual disabilities (ID), which has an impact on the development of PA promotion programmes. Peer social connectedness seems to be a vital correlate to focus on, but has not been included in current studies examining the correlates and determinants of PA levels of young people with ID. This study aims to synthesise the evidence on (1) the social constructs researchers have used to conceptualise peer social connectedness in a PA context among young people with ID, (2) the measurement tools that have been used and (3) the relationship between PA and peer social connectedness in young people with ID.

METHODS

The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Ovid MEDLINE, Ovid Embase, Web of Science, ERIC, CINAHL and PsycINFO were searched from 1 January 1996 up to, and including, July 2023 to identify English-language studies, which examined associations between PA and peer social connectedness in adolescents and young adults (13-24 years) with ID. Study quality was assessed using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields.

RESULTS

Thirteen studies met the inclusion criteria and were included in the review. Ten peer social connectedness constructs and 18 measurement instruments were identified. Studies were predominantly focused on Special Olympics participants and unified activity formats. Participation in PA can increase social connectedness, but there is a lack of studies examining whether PA can also be increased by focusing on peer social connectedness in young people with ID.

CONCLUSIONS

Results show that peer social connectedness is recognised as relevant to researchers developing and testing PA programmes for young people with ID.

The physical and psychosocial impact of a school-based running programme for adolescents with disabilities

BACKGROUND

Adolescents with disabilities have fewer opportunities to participate in community-based fitness programmes. The purpose of this study was to examine the impact of a school-based running programme at a local middle school in Lebanon, Pennsylvania, on fitness and quality of life (QoL) in children with physical and cognitive disabilities in a life-skills classroom.

METHODS

Nineteen adolescents with diagnosed disabilities including intellectual disability (ID), autism spectrum disorder and Down syndrome were recruited from three life-skills classrooms to participate in a school-based running programme. The programme was designed to be implemented two times/week for 6 weeks by classroom teachers/aides. Physical therapy faculty and students developed the programme and assisted with implementation. Each session lasted 30 min, consisting of a warm-up and cooldown, relay races, games and timed runs. Pre- and post-test measures included physiological cost index (PCI) and Paediatric Quality of Life Inventory™ (PedsQL™). Pre- and post-test data were compared using Wilcoxon signed rank tests. Each week participants also completed a training log to reflect on the activity for the day.

RESULTS

Participants demonstrated significant improvements in PCI (P = 0.028) and the PedsQL™ (P = 0.008) following the running programme.

CONCLUSIONS

Results of this study suggest that participation in a 6-week school-based running programme may improve fitness and QoL in adolescents with disabilities.

Postural Balance in Boys With Intellectual Disabilities Who Participate in Soccer Training

PURPOSE

The aim of this study is to investigate the postural balance in children with intellectual disabilities who participate in soccer training compared with their sedentary peers.

METHOD

Two groups of boys with intellectual disabilities aged 8-10 years participated in this study: a soccer group (n = 12) and a sedentary group (n = 12). Postural balance was assessed using a force platform under 4 different conditions: open eyes, and closed eyes, on firm and foam surfaces. The Timed Up and Go Test, 10-m Walking Test, and Four-Square Step Test were also conducted.

RESULTS

The soccer group had significantly lower (P < .05) center of pressure values compared with the sedentary group, on both firm and foam surfaces, but only under the open eyes condition. They were significantly faster (P < .05) in the Timed Up and Go Test, 10-m Walking Test, and Four-Square Step Test compared with their sedentary peers. However, there were no significant differences between the 2 groups on the sit-to-stand and turn-to-sit phases of the Timed Up and Go Test.

CONCLUSION

Soccer participation may have a positive effect on postural balance in boys with intellectual disabilities. These findings may have implications for the development of exercise programs to improve postural balance and reduce the risk of falls in this population.

Synergizing the Behavior Change Wheel and a Cocreative Approach to Design a Physical Activity Intervention for Adolescents and Young Adults With Intellectual Disabilities: Development Study

BACKGROUND

There is a need for physical activity promotion interventions in adolescents and young adults with intellectual disabilities. Current interventions have shown limited effectiveness, which may be attributed to the absence of theory and a population-specific development. Combining a planning model (including theory) and cocreation with the target audience during intervention development could potentially address this gap.

OBJECTIVE

This study aimed to report the systematic development of the Move it, Move ID! intervention by describing how the 8 different steps of the Behavior Change Wheel (BCW) were applied and present the results that emerged from those steps. In doing so, the (theoretical) content of the intervention is described in detail.

METHODS

A total of 23 adolescents and young adults (aged 14-22 years) with mild to moderate intellectual disabilities were designated as cocreators of the intervention. Across 2 groups, 6 similar cocreation sessions were organized in each. The content and sequence of the sessions were structured to align with the 8 steps of the BCW. All sessions were recorded and transcribed verbatim. Both a deductive (ie, steps of the BCW) and inductive (ie, resonating the voice of the participants) analysis approach were applied specifically focusing on identifying and describing the findings within each of the BCW steps.

RESULTS

After behavioral analysis (steps 1-4), 10 intervention goals were chosen and linked to Capability, Opportunity, and Motivation-Behavior components (theory within the BCW) that needed to be addressed. Psychological capability, social opportunity, and reflective motivation were emphasized as the first targets to focus on. A key finding was the urge for real-life social connectedness and social integration, which makes the social component as part of physical activity a central theme to focus on within intervention development. Judgments on the most suitable intervention functions (step 5) and behavior change techniques (step 7) were explained. When discussing the mode of delivery of the intervention (step 8), it was underscored that solely relying on a mobile health app would not fulfill participants' social needs. Hence, the chosen intervention adopts a dyadic approach in which young individuals with intellectual disabilities are matched with peers without intellectual disabilities to engage in physical activities together, with a mobile app playing a supportive role in this partnership.

CONCLUSIONS

The transparent description of the development process highlights why certain intervention components and behavior change techniques were chosen and how they are intertwined by means of the selected intervention design. This paper provides a detailed blueprint for practitioners wanting to integrate the BCW and its associated behavior change techniques, in combination with actively involving the target group, into their intervention development for people with intellectual disabilities.

The Associations Between Accelerometer-Measured Physical Activity Levels and Mental Health in Children and Adolescents with Intellectual Disabilities During the COVID-19 Pandemic

To examine the associations between physical activity (PA) levels and mental health in children and adolescents with intellectual disabilities (IDs) during the COVID-19 pandemic, 117 participants aged between 6 and 17 years with IDs from 10 Hong Kong special schools were included. There were positive dose-response associations between PA (i.e., light PA, moderate PA, and vigorous PA) and mental health, and participants with higher levels of moderate-to-vigorous PA (MVPA) and self-concept (SC) had better social quality of life (QoL) than those with lower levels of MVPA and SC. Moreover, personal and environmental factors such as age, body mass index, school, sex, ID level, and parental education level influenced the PA levels and QoL in children and adolescents with IDs.

Moderate-to-vigorous intensity physical activity levels of children with intellectual disability during physical education classes

Background

Physical education (PE) class is an excellent way to improve moderate-to-vigorous intensity physical activity (MVPA). Increasing number of research has explored the children's PA based on movement during PE classes, but data for children with intellectual disability (ID) is still lacking.

Purpose

The purpose of this study was to investigate the current status of MVPA levels of children with ID during PE classes in China, as well as differences of MVPA levels according to gender and grade.

Methods

Accelerometers were used to record MVPA levels of fifty-three children with severe ID from 9 to 16 years of age (mean age: 12.60 ± 1.66 years) during standard PE classes.

Results

The mean time spent in MVPA during PE classes was 8.00 ± 2.10 min, meaning only 22.88% of PE class time was spent in MVPA. As grade levels progresses, time spent in MVPA during PE classes tended to decrease; the fourth-grade children tended to spend more time in MVPA during PE classes compared with the fifth-grade and the sixth-grade (9.15 vs. 7.61 vs. 7.25 min, all p < 0.05). Boys spend significantly more time in MVPA during PE classes than girls; both in the entire sample (9.20 vs. 5.70 min) as well as in each grade (9.76 vs. 6.09 min, 9.35 vs. 5.68 min, 8.31 vs. 5.59 min, all p < 0.05).

Conclusion

Findings from this study indicate that the proportion of PE class spent in the MVPA of children with ID was lower than the 50% recommended by the U.S. Department of Health and Human Services (DHHS) and U.K. Association for Physical Education (AfPE). And the amount of MVPA participation varied by the grade and gender as well as by the activity performed. Therefore, in order to help children with ID achieve MVPA goals, educators need to reevaluate the PE curriculum as well as take due consideration of grade and gender when devising new content.

Effects of rope skipping exercise on physical, cardiovascular fitness and exercise tolerance in adolescent students with moderate intellectual disability

BACKGROUND

Adolescents with intellectual disabilities (ID) who live a sedentary lifestyle may lead to an increased risk of chronic cardiovascular disease in adulthood. The aim of this study is to investigate the effects of 8-week progressive rope skipping training on physical, cardiovascular fitness and exercise tolerance of high school students with moderate ID.

METHODS

Thirty-four senior high school with ID (aged 15-18 years old) were randomised into experimental group received progressive skipping rope exercise (RS, n = 17) and control group no rope skipping exercise intervention group (CON, n = 17). The RS group were received progressive rope skipping exercise for 50 min each time, three times a week, for 8 weeks. The control group was not allowed to participate in intervention activities during the study period. The physical fitness, body composition, arterial stiffness index (ASI) and blood pressure were measured before and after the 8-week intervention.

RESULTS

After the 8-week progressive skipping rope exercise intervention, the participants from the RS group increased in the 3-min step test, sit-up test, grip strength and sit and reach test, when compared to the baseline (P < 0.05). The RS group exhibited lower the area under curve of heart rate (HR) during post-exercise recovery (P < 0.05). The participants in the RS group showed significant decreases in systolic (SBP) and diastolic (DBP) blood pressure, mean arterial pressure (MAP) and HR when compared to the baseline (P < 0.05). Change SBP has moderate positive correlation with change ASI.

CONCLUSIONS

The results of this experiment suggest that progressive rope skipping exercise might improve physical fitness and promote cardiovascular health, as well as enhance exercise tolerance for adolescent students with moderate ID.

Associations between motor competence and physical activity levels of children with intellectual disabilities and/or autism spectrum disorder: Movement matters

Motor competence is important for lifelong physical activity (PA). The current study aimed to examine associations between PA and motor competence. In total, 43 children aged 7-12 years with intellectual disabilities and/or autism spectrum disorder completed anthropometric measures, the Bruininks-Oseretsky Test of Motor Proficiency-2, and wore a wrist accelerometer to capture total PA, moderate-to-vigorous PA (MVPA), average acceleration, and intensity gradient. No significant associations were found between PA outcomes and motor competence. Motor competence performance was commonly 'below average' or 'average'. The weakest subtests were upper limb coordination and strength. The strongest subtest was running speed and agility. Total weekly MVPA was 336.1 ± 150.3 min, higher than UK recommendations of 120-180 per week for disabled children and young people. Larger scale studies are needed to better understand the relationship between PA and motor competence. Future research should also consider the influence of environmental factors on PA in this group.

Exploring the effects of physical exercise on inferiority feeling in children and adolescents with disabilities: a test of chain mediated effects of self-depletion and self-efficacy

Objective

The purpose of this study was to investigate the effects of physical exercise on inferiority feeling of children and adolescents with disabilities and its mechanism of action, as well as the mediating role of self depletion and self-efficacy.

Methods

The following scales were administered to 546 children and adolescents with disabilities (mean age 15.6 years): The Feelings of Inadequacy Scale, (FIS), the Self-Regulation Fatigue Scale (S-RFS), the General Self-Efficacy Scale (GSES), and the Physical Exercise Rating Scale.

Results

(1) Physical exercise can directly and negatively predict inferiority feeling, self-depletion, and can directly and positively predict self-efficacy; self-depletion can directly and negatively predict self-efficacy. Similarly, self-depletion positively predicts inferiority feeling; physical exercise and self-efficacy can also directly and negatively predict inferiority feeling. (2) The indirect effect of the path with self-depletion as the mediating variable was - 0.05, the indirect effect of the path with self-efficacy as the mediating variable was - 0.09, and the indirect effect of the path with self-depletion and self-efficacy as the mediating variables was - 0.04. (3) The sum of all indirect effects was - 0.18, and the three indirect effects accounted for 15.6%, 28.1%, and 12.5% of the total effect, with mediating effect was 56.2%.

Conclusion

Physical exercise can indirectly predict inferiority feeling in children and adolescents with disabilities through the independent mediation of self-depletion and self-efficacy, as well as through the chain mediation of both. This study supports that moderate physical exercise has a positive effect on the mental health of children and adolescents with disabilities, and that reducing self-depletion and improving self-efficacy are important ways to prevent inferiority feeling among children and adolescents with disabilities. It reveals the relationship between physical exercise and inferiority feeling and its mechanism of action, and further improves the research on the effect of physical exercise on inferiority feeling of children and adolescents with disabilities.

Physical Activity and Quality of Life among People with Intellectual Disabilities: The Role of Gender and the Practice Characteristics

Staying physically active is synonymous with good health and well-being, and its benefits on the health of people with intellectual disabilities (PWIDs) have been studied. However, there is a lack of information on how it can influence their quality of life (QoL). This study aimed to analyze the relationship between QoL and physical activity in PWIDs according to gender and the characteristics of the practiced activity. A questionnaire was administered to 380 PWIDs (mean age of 28.23 ± 12.53), 54.21% of which were men. The QoL dimensions and second-order factors were studied in relation to practicing physical activity, the practice type, the context, and gender. The results indicate that people who practiced any activity showed better QoL values. Those who engaged in a nonregulated physical activity had better values in self-determination, emotional well-being, social inclusion, and personal development, while those who did sports presented higher scores in interpersonal relationships and physical well-being. In addition, it also appears that the association between physical activity and the QoL dimensions is distinct in inclusive and specific contexts. In conclusion, physical activity is related to a better QoL, although the impact of the practice type and context differs for each QoL dimension.

The effect of increasing exercise in the intellectually disabled community

BACKGROUND

Intellectually disabled individuals have been observed to lead sedentary lifestyles resulting in poor health. Physical fitness has been positively correlated to better health outcomes with small changes in fitness translating to major health changes among unfit older adults with intellectual disability. However, there is currently no literature on safe exercise regimens for the intellectually disabled population.

METHODS

In this article, a retrospective review was conducted using the Special Olympics Athlete database and analyzed the mean differences of various performance metrics based on self-reported exercise frequency.

RESULTS

These results demonstrated that those who exercised daily performed significantly better in flexibility, static balance and functional strength as compared to those who did not exercise. No statistically significant differences were found among athletes and self-reported exercise frequency for aerobic fitness.

CONCLUSION

Overall, these findings suggest that 3-6 days-a-week of moderate exercise would be a recommended exercise dose to see significant improvement in performance and physiological adaptations.

Physical activity in young children across developmental and health states: the ActiveCHILD study

Background

Evidence about physical activity of young children across developmental and health states is very limited. Using data from an inclusive UK cohort, ActiveCHILD, we investigated relationships between objectively measured physical activity, child development, social context, and health-related quality of life (HRQoL).

Methods

Children (12-36 months), purposively sampled across health pathways, developmental abilities, and sociodemographic factors, were recruited through thirteen National Health Service organisations in England. Data were collected from 07/2017 to 08/2019 on: weekly physical activity (3-7 days) using waist-worn accelerometer (ActiGraph 3GTX); sociodemographics, parent actions, child HRQoL, and child development using questionnaires; and child health conditions using clinical records. A data-driven, unsupervised method, called hidden semi-Markov model (HSMM) segmented the accelerometery data and provided estimates of the total time spent active (any intensity) and very active (greater intensity) for each child. Relationships with the explanatory factors were investigated using multiple linear regression.

Findings

Physical activity data were obtained for 282 children (56% females, mean age 21 months, 37.5% with a health condition) covering all index of multiple deprivation deciles. The patterns of physical activity consisted of two daily peaks, children spending 6.44 (SD = 1.39) hours active (any intensity), of which 2.78 (SD = 1.38) hours very active, 91% meeting WHO guidelines. The model for total time active (any intensity) explained 24% of variance, with mobility capacity the strongest predictor (β = 0.41). The model for time spent very active explained 59% of variance, with mobility capacity again the strongest predictor (β = 0.76). There was no evidence of physical activity explaining HRQoL.

Interpretation

The findings provide new evidence that young children across developmental states regularly achieve mainstream recommended physical activity levels and challenges the belief that children with development problems need lower expectations for daily physical activity compared to peers. Advancing the rights of all children to participate in physical activity requires inclusive, equally ambitious, expectations for all.

Funding

Niina Kolehmainen, HEE/NIHR Integrated Clinical Academic Senior Clinical Lecturer, NIHR ICA-SCL-2015-01-00, was funded by the NIHR for this research project. Christopher Thornton, Olivia Craw, Laura Kudlek, and Laura Cutler were also funded from this award. Tim Rapley is a member of the NIHR Applied Research Collaboration North East and North Cumbria, with part of his time funded through the related award (NIHR200173). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, NHS, or the UK Department of Health and Social Care. The work of Kianoush Nazarpour is supported by Engineering and Physical Sciences Research Council (EPSRC), under grant number EP/R004242/2.

Dyadic Predictors of Willing to Engage in Physical Activity and Emotional Eating in Children and Adolescents with Mild and Moderate Intellectual Disability

Intellectual disability is associated with increased risk for childhood obesity, and the factors most often associated with this risk are incorrect eating behavior and insufficient amount and intensity of physical activity. As is well known, there area whole range of factors determining lifestyle, but many currently available reports in this field refer to the functioning of children without a diagnosis of intellectual disability, and, as we know, due to numerous individual and environmental barriers, children with ID may function differently in this context than their peers. Therefore, we examined the relationships between the selected variables and divided them into two models: (1) first regression model: child's willingness to engage in physical activity (dependent variable), child's physical limitations related to disabilities and/or comorbidities, child's independence, parents' willingness to engage in physical activity, child's body dissatisfaction (independent variables/predictors); (2) second regression model: child's emotional eating (dependent variable), child's coping with emotions, parents' attitudes, beliefs, and practices about child feeding (restriction and pressure to eat), parents' emotional eating, parents' happiness (independent variables/predictors). A group of 503 parents (of children and adolescents with mild and moderate intellectual disability) completed: the Contour Drawing Rating Scale, the Child Feeding Questionnaire, the Emotional Overeating Questionnaire, the Scale of Experiencing Happiness, and the supplementary survey. Our results allow partial confirmation of the hypotheses related to both of these models: (1) model I: the relationships between the child's willingness to engage in physical activity and all predictors are significant, but the direction of the relationship between the dependent variable and one of the predictors-body dissatisfaction-is opposite to the assumed one (negative relationship); (2) model II: the relationships between the child's emotional eating and almost all predictors are significant, except for the relationship between the dependent variable and pressure to eat. In conclusion, (to the authors' knowledge) this study is the first to assess dyadic predictors of willingness to engage in physical activity and emotional eating in children and adolescents with mild and moderate intellectual disability. It allows for a better understanding of the attitudes, beliefs, and experiences of children with intellectual disabilities and their parents, which gives the opportunity (taking into account factors from both individuals from the child-parent dyad) to better design strategies to support pro-health behaviors in children and adolescents from this group (which may improve the effectiveness of overweight prevention and obesity). These findings emphasize how important it is to consider the dynamic of the child-parent dyad when considering how parenting contributes to a child's willingness to engage in physical activity, as well as thatchild's emotional eating.

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

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

Impact of adapted bicycle riding on outcomes for children and adolescents with disabilities: A systematic review

AIM

To review the evidence for the effects of adapted bicycle riding on body structures and functions, activity, participation, and quality of life outcomes in children with disabilities, along with family-level participation outcomes.

METHOD

A systematic review with searches of nine electronic databases to identify studies involving participants with a developmental disability aged 4 to 18 years who used a dynamic adapted bicycle was completed in August 2021. Risk of bias was assessed based on individual study designs. A narrative synthesis integrated the findings of the included studies. Certainty of evidence was synthesized using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

RESULTS

Ten studies were included with 234 participants. Five studies reported outcomes at the body structures and functions level, ten reported activity-level outcomes, two reported participation-related outcomes, and none assessed quality of life or family participation in social and recreational activities.

INTERPRETATION

Adapted bicycle riding interventions may improve gross motor function, enhance lower-limb muscle strength, and promote physical activity; however, certainty of evidence of effects was rated very low using GRADE. Further research is required to understand the impact of adapted bicycle riding on the participation outcomes of children and adolescents with disabilities and on family-level participation in social and recreational activities.

WHAT THIS PAPER ADDS

Adapted bicycle riding interventions may improve motor functions and physical activity. Evidence about participation outcomes after adapted bicycle riding is limited. Research on adapted bicycle riding interventions in natural settings is needed.

Mental and Physical Health, Psychosocial Maturity, and Desistance in Young Adulthood

Recent theoretical and empirical work has drawn increased attention to the role that mental and physical health can play in promoting life-course success and desistance from crime. This study integrates literature on youth development with the health-based desistance framework to investigate a key developmental pathway through which health influences desistance among system-involved youth. Using multiple waves of data from the Pathways to Desistance Study, the current study uses generalized structural equation modeling to examine whether and to what extent mental and physical health influence offending and substance use directly and indirectly through psychosocial maturity. Findings indicate that both depression and poor health stall the development of psychosocial maturity, and that those with higher psychosocial maturity are less likely to engage in offending and substance use. The model provides general support for the health-based desistance framework, finding an indirect process linking better health states to normative developmental desistance processes. Results hold important implications for the development of age-graded policies and programs geared toward promoting desistance among serious adolescent offenders both within correctional and community settings.

What has been done to improve learning for intellectual disability? An umbrella review of published meta-analyses and systematic reviews

BACKGROUND

Intellectual disability (ID) affects 1%-3% of the paediatric population. Currently, there is no consensus as to the most effective strategies for improving the learning skills of children and adolescents with ID. This review aims to systematically gather information regarding interventions to promote and improve learning skills in children/adolescents with ID from previously published systematic reviews and meta-analyses.

METHODS

Systematic search strategies, including appropriate descriptors, were employed on Medline, Cochrane, Scopus, Web of Science, Lilacs, SciELO, ERIC, and PsycINFO databases. Quality assessment was conducted via the AMSTAR-2.

RESULTS

Fifty-nine studies were selected, subdivided by outcome domains and by the type of intervention. Interventions were related to caregiving, education, pharmaco-dietary, physical, and technology approaches. The overall low quality of the studies limited our recommendations.

The influence of meaningful activities in the quality of life and functional autonomy of adults with intellectual disability: A prospective study during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic might negatively impact the quality of life and functional autonomy of Spanish adults with intellectual disability, and meaningful activities could prevent this negative progression.

METHODS

This is a prospective cohort study in Spanish adults with intellectual disability during the COVID-19 pandemic. Quality of life, functional autonomy and functional independence were measured. The meaningful activities studied were structured-leisure, community self-management, and occupational and physical activities.

RESULTS

Seventy-three participants were included in the study. Quality of life and functional autonomy significantly deteriorated during the COVID-19 pandemic (all p > .001). Greater participation in community self-management activities before COVID-19 was associated with less detriment to quality of life (ß = -.312; p = .008), while greater participation in occupational and physical activities was associated with less detriment to the performance of instrumental activities (ß = -.317; p = .016; and ß = -.285; p = .030, respectively).

CONCLUSION

People with intellectual disability living in residential homes experienced a decrease in their quality of life and functional autonomy during the COVID-19 pandemic. Their involvement in community self-management activities and physical and occupational activities before the pandemic had preventive effects on the detriment to the quality of life and functional autonomy.

The athletic work force: Sport as a key to employment for people with intellectual disabilities?

BACKGROUND

People with disabilities are employed at lower rates than non-disabled individuals and, among people with disabilities, those with intellectual disabilities have most difficulty finding and keeping employment. The reasons for the low labour participation among people with intellectual disabilities are many. Sport participation has a number of positive effects for the individual, and it is reasonable to hypothesise that sport participation favours labour-force participation for individuals with intellectual disabilities.

OBJECTIVE

The dual aim of the current study was to investigate labour market participation among Swedish athletes with intellectual disabilities attending Special Olympics Invitational Games, and to investigate these athletes' experiences regarding the effect of sport participation on finding and keeping a job.

METHOD

The study design includes two parallel data collections, a survey and an interview study. The survey was analysed using descriptive statistics and the interviews were analysed using content analysis.

RESULTS

The major result of the survey was the large number of individuals with intellectual disabilities who were in work: among men, 72% and, among women, 44%. This result was encouraging and differs from previous statistics on employment among Swedes with intellectual disabilities. The content analysis resulted in a first step in the categories manual work, individual sports and team sports, and in a second step, where the relation between sports and work was analysed, in two categories, namely indirect and direct relations between sport and work.

CONCLUSION

To improve chances for individuals with intellectual disabilities to find and keep a job, sports participation should be encouraged.

"Cost-effectiveness of ACL treatment is dependent on age and activity level: a systematic review"

PURPOSE

To systematically review the literature on health-economic evaluations of anterior cruciate ligament (ACL) injury between reconstruction surgery (ACLR) and non-operative treatment (NO) and suggest the most cost-effective strategy between the two.

METHODS

All economic studies related to ACLR versus NO post-ACL injury, either trial based or model based, published until April 2022, were identified using PubMed and Embase. The methodology of the health-economic analysis for each included study was categorized according to the four approaches: cost-minimization analysis (CMA), cost-effectiveness analysis (CEA), cost-benefit analysis (CBA), and cost-utility analysis (CUA). The quality of each included study was assessed using the Consensus on Health Economic Criteria (CHEC) list.

RESULTS

Of the seven included studies, two compared the strategies of early ACLR and NO alone, and five compared early ACLR and NO with optional delayed ACLR. All studies performed a CUA, and one study performed a CBA additionally. The CHEC scores of the included studies can be considered good, ranging from 15 to 18 from a maximum of 19. Applying the common standard threshold of $50,000 per QALY, six studies in young people with high-activity levels or athletes showed that early ACLR would be preferred over either NO alone or delayed ACLR. Of six studies, two even showed early ACLR to be the dominant strategy over either NO alone or delayed ACLR, with per-patient cost savings of $5,164 and $1,803 and incremental per-patient QALY gains of 0.18 and 0.28, respectively. The one study in the middle-aged people with a moderate activity level showed that early ACLR was not more cost-effective than delayed ACLR, with ICER $101,939/QALY using the societal perspective and ICER $63,188/QALY using the healthcare system perspective.

CONCLUSION

Early ACLR is likely the more cost-effective strategy for ACL injury cases in athletes and young populations with high-activity levels. On the other hand, non-operative treatment with optional delayed ACLR may be the more cost-effective strategy in the middle age population with moderate activity levels.

LEVEL OF EVIDENCE

Systematic review of level III studies.

Facilitators and Barriers to Physical Activity Involvement as Described by Autistic Youth with Mild Intellectual Disability

Objectives

Physical activity involvement among autistic youth and youth with an intellectual disability is significantly lower than the general population. Few studies have included youth with comorbid diagnoses of ASD and intellectual disability. Fewer studies collect information from the youth themselves. This study examined barriers and facilitators to physical activity in autistic youth with mild intellectual disability using semi-structured interviews with youth and through caregiver reports.

Methods

Fourteen caregivers and their children ages 8 to 16 years old participated. Caregivers completed a questionnaire about their thoughts on their child's physical activity while their children completed the semi-structured interview. A descriptive phenomenological approach was followed.

Results

Four themes were inductively identified: intrapersonal barriers (factors that are within the person which impede physical activity involvement, such as exhibiting challenging behaviors that inhibit engagement), interpersonal barriers (factors external to the person, such as lack of community support), intrapersonal facilitators (factors within the person that enhance physical activity involvement, such as being intrinsically motivated to improve skills), and interpersonal facilitators (external factors such as supports from caregivers).

Conclusions

Interviewing youth is important to capture a holistic picture of factors influencing physical activity. Future research may focus on implementing and assessing the efficacy of strategies to address the barriers facing youth diagnosed with ASD and intellectual disability.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41252-022-00310-5.

Effect of a Cognitive Function and Social Skills-Based Digital Exercise Therapy Using IoT on Motor Coordination in Children with Intellectual and Developmental Disability

This study aimed to determine the effects of a virtual reality exercise program based on cognitive function and social skills on motor coordination in children with intellectual and developmental disabilities (IDD). Thirty-five children with IDD were randomly assigned to either the cognitive function and social skills-based virtual reality exercise system (CS-VR) group or the conventional virtual reality exercise system (C-VR) group. Before and after the intervention, each participant was tested for motor coordination (extended horizontal jump, hop, stationary dribble, overarm throw) and exercise performance (standing long jump, YMCA step test). Compared with the C-VR group, the CS-VR group showed significant improvements in motor coordination in terms of extended horizontal jump, hop, and overarm throw (p < 0.01, p < 0.05, and p < 0.01, respectively). In addition, compared with the C-VR group, the CS-VR group showed a significant increase in standing long jump (p < 0.01), although no significant between-group variation was found in stationary dribble and recovery heart rate (RHR) as part of the YMCA step test (p > 0.05, and p > 0.05, respectively). These results suggest that for the development of motor skills in children with IDD, it is essential to develop an exercise program that reflects the levels of cognitive functions and social skills of these children.

Physical activity, sedentary behaviour and screen time among youths with Down syndrome during the COVID-19 pandemic

BACKGROUND

The COVID-19-related restrictions hampered habitual physical activity (PA), particularly affecting the more vulnerable, such as people with Down syndrome (DS). The study aimed to investigate changes in PA, sedentary behaviour (SB) and screen time (ST) of youths with DS, before, during and after the restrictions, also in relation to parental PA levels.

METHODS

A cross-sectional design with a retrospective assessment of variables for the before and during restrictions periods was adopted. Parents of youths with DS completed an online questionnaire. Sociodemographic aspects, weekly PA levels and youths' daily SB and ST were investigated, referring to three time-points: before the pandemic, during the restrictions and the restrictions-easing phase.

RESULTS

A total of 57 parents voluntarily participated in the study, proxy-reporting on their child (male = 41, female = 16, age = 21.4 ± 7.7 years). A repeated measures multivariate analysis of variance showed negative effects of restrictions (P < 0.05) on PA levels, SB and ST, independently from sociodemographic characteristics. In the restrictions-easing phase, PA levels did not return to before the pandemic values (P < 0.05). A positive correlation between parents and their child's PA was detected before the pandemic (r = 0.38; P < 0.01), no longer reported in the restrictions-easing phase.

CONCLUSIONS

The findings showed the negative impact of restrictions on youths with DS lifestyle. Moreover, the importance of addressing the needs of the disabled community including the whole family is highlighted.

Adaptive behavior, sleep, and physical activity in adolescents with fetal alcohol spectrum disorder

BACKGROUND

Fetal alcohol spectrum disorder (FASD) is broadly associated with impairments to adaptive behavior and dysfunctional sleep. Associations between sleep, adaptive behavior, and physical activity are frequently drawn in discussions of typical development and other clinical conditions.

AIMS

In this study, we sought to characterize patterns of sleep, adaptive behavior, and physical activity in adolescents with FASD. We also investigated the associations between sleep, adaptive behavior, and physical activity within this population.

METHODS AND PROCEDURES

Twenty-seven adolescents aged 11- to 17-years with a diagnosis of FASD and their caregivers participated in this study. All participants completed parent and youth questionnaires on adaptive behavior, sleep, and physical activity.

OUTCOMES AND RESULTS

Adolescents with FASD displayed significant impairments to all domains of adaptive behavior and considerable sleep disturbance. Worse sleep was associated with older age and sleep-related breathing disturbances were associated with poorer social adaptive behavior. Participation in physical activity, particularly organized sport, was strongly associated with better adaptive behavior.

CONCLUSIONS AND IMPLICATIONS

Adolescents with FASD experience considerable challenges with regards to sleep and adaptive behavior. Physical activity, particularly organized sport, may provide opportunities for the improvement of adaptive behavior in this population.

Physical activity and sedentary behaviour among children and adolescents with intellectual disabilities during the COVID-19 lockdown in China

BACKGROUND

In the wake of the COVID-19 pandemic, preliminary research has reported a significant decline in physical activity (PA) and an increase in sedentary behaviour (SB) among typically developed children and adolescents. Limited research has looked at the current situation of PA and SB during this pandemic among children and adolescents with intellectual disabilities (ID). This study investigated the situations about PA and SB among school-aged children and adolescents with ID on China's mainland during the COVID-19 outbreak.

METHODS

In total, 837 parents of children and adolescents (ages 6-18 years) with ID from 15 special education schools of Shandong Province in China were recruited through convenience sampling in the study. Parents reported PA and SB among children and adolescents with ID through the Children's Leisure Activities Study Survey-Chinese version (CLASS-C) online questionnaires.

RESULTS

From parents' reports, Chinese children and adolescents with ID during the COVID-19 pandemic participated in approximately 10 min of moderate-to-vigorous physical activity, and engaged in approximately 530 min of SB every day. Meanwhile, only 17.4% of children and adolescents with ID were able to achieve the recommendation of 60 min of daily moderate-to-vigorous physical activity and 76.1% of children and adolescents with ID spent more than 2 h on SB per day. Additionally, the problems of decrease PA and excessive SB were more prominent in older adolescents with ID compared with younger children with ID.

CONCLUSION

In China, the low level of PA and high level of SB is particularly evident in children and adolescents with ID during the outbreak of COVID-19. The great majority of children and adolescents with ID did not meet the recommended amount of PA while undergoing excessive SB under the long-term home quarantine environment. Therefore, immediate attention and great effort should be made to deal with this severe situation among this vulnerable population in the mainland of China.

A psychometric validation of the motives for physical activity measure for youth with intellectual disabilities (MPAM-ID)

PURPOSE

To validate a version of the Motives for Physical Activity Measure (MPAM) adapted for youth with intellectual disabilities (ID).

MATERIALS AND METHODS

A sample of 359 youth with mild to moderate ID from Australia and Canada respectively completed English and French versions of the MPAM-ID.

RESULTS

Exploratory structural equation models supported the validity and reliability of the five-factor structure of the MPAM-ID, as well as the weak, latent variance-covariance, and latent mean invariance across linguistic versions. Additional results supported the partial strong and strict invariance of most MPAM-ID items across linguistic versions. The results also supported the complete measurement invariance of the MPAM-ID over time and revealed a lack of differential item functioning (DIF) as a function of youth's age, body-mass index (BMI), ID level, and frequency of sport involvement (FSI). However, partial DIF was found as a function of youth's sex. Additionally, latent mean differences in MPAM-ID's factors were found as a function of youth's ID level, sex, and FSI. Finally, results supported the convergent validity of the MPAM-ID factors with a measure of perceived physical abilities.

CONCLUSION

The MPAM-ID can be used among English- and French-speaking youth with ID irrespective of their age, BMI, ID level, sex, and FSI.IMPLICATIONS FOR REHABILITATIONWe propose English and French adaptations of the Motives for Physical Activity Measure for Youth with Intellectual Disabilities (MPAM-ID).The MPAM-ID was able to identify the same motives as the original measure.The MPAM-ID will facilitate the assessment of motives for physical Activity in cross-sectional and longitudinal studies.The MPAM-ID will facilitate the assessment of motives for physical Activity among English- and French-speaking youth with ID.The MPAM-ID could be used to compare youth motives for physical Activity as a function of their age, body-mass index, ID level, and frequency of sport involvement.

Family factors associated with physical activity in children with intellectual disability: A systematic review

This systematic review aimed to explore the influence of family factors on physical activity in children with intellectual disability. How and what family factors that specifically influence physical activity has not been compiled and reviewed previously. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search was performed for articles published in English and Chinese without any year limits in six databases. Ten studies met the eligibility criteria and were included in the review. All studies were qualitatively integrated to identify and compare positive and negative family factors. A total of 1135 participants, of which 497 were children with intellectual disability while the other 638 participants were family members (parents, siblings and caregivers). The family factors of 6 themes and 18 sub-themes (10 positive, 7 negative and 1 inconclusive factors) were extracted. Overall, these results highlight the importance of encouragement, support and involvement by family members, concurrently it points out that parental psychological factors, socioeconomic status, responsibilities and electronic devices could both promote and hinder engagement in physical activity for children with intellectual disability. The findings accentuate the role of the family unit in helping determine the activity levels of children with intellectual disability. Future studies should include a wider range of participants and be longitudinal in nature, utilizing more accurate monitoring tools.

"Sports for All"-An Evaluation of a Community Based Physical Activity Program on the Access to Mainstream Sport for Children with Intellectual Disability

Access to club sports is still not a given for children with ID. Parents and children report numerous structural and social barriers to accessing mainstream sports. Sports clubs, on the other hand, want to include this group of people, but often do not know how to do it. Using a community-based approach, children with intellectual disabilities (8-15 years) and their parents were given the opportunity to participate in an 8-week sports program in four mainstream clubs organized by a self-help organization for people with intellectual disabilities. Focus groups were conducted with all participants (parents, children, and club representatives) before and after the program and evaluated by means of a thematic analysis. The children rated participation very positively and only very occasionally reported that they had been excluded. The parents confirmed this experience, but were nevertheless more critical in their assessment. Outside the research context of this study, the sports clubs hardly provided good support, which can also be deduced from previous negative experiences of the parents. The sports clubs themselves received valuable information about what their failings were: sufficiently available and qualified staff, better access to sports facilities, and a wider range of inclusive groups are needed. On the other hand, there was hardly any prejudice on the part of the non-disabled club members towards the new members with ID, which was evaluated extremely positively, albeit surprisingly, by the sports clubs.

Physical activity and mental health in children and adolescents with intellectual disabilities: a meta-analysis using the RE-AIM framework

BACKGROUND

Children and adolescents with intellectual disabilities (IDs) tend to have lower levels of physical activity and poorer mental health than their typically developing peers. Studies on the effects of physical activity on the mental health of children with IDs using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework are scarce.

METHODS

A systematic literature review using six databases (CINAHL, Eric, PsycINFO, PubMed, SPORTDiscus, and Web of Science) was conducted from January 2000 to September 2021. Studies reporting at least one physical activity intervention and mental health outcome in children and adolescents with IDs aged between 5 and 17 years were included in the meta-analysis. Preferred Reporting Items for Systematic Review and Meta-Analysis guideline, Comprehensive Meta-Analysis, and the RE-AIM framework were utilized.

RESULTS

A total of 15 studies that met the inclusion criteria were included in the meta-analysis. The effects of physical activity on mental health in children and adolescents with IDs were significant and large (Hedges' g = 0.897, p < 0.01), with medium effects on psychological health (Hedges' g = 0.542, p < 0.01) and large effects on cognitive function (Hedges' g = 1.236, p < 0.01). Randomized controlled trial (RCT) design and intervention components (> 120 minutes per week, therapeutic, and aerobic exercise) demonstrated the strongest effects. Moreover, study background (publication year, study location, and sample size), participant characteristics (age and sex), and Maintenance (RE-AIM framework) moderated the effects of physical activity on mental health. Based on the RE-AIM framework, there were higher proportions in the dimensions of Reach and Effectiveness than Adoption, Implementation, and Maintenance.

CONCLUSIONS

Physical activity appears to have positive effects on mental health, including psychological health and cognitive function, in children and adolescents with IDs. Physical activity interventions using the RE-AIM framework are recommended to assess short- and long-term impacts and translate scientific evidence into practice.

TRIAL REGISTRATION

The protocol for this meta-analysis was registered with PROSPERO ( CRD42021256543 ).

Mental health problems in children with intellectual disability

Intellectual disability ranks in the top ten causes of disease burden globally and is the top cause in children younger than 5 years. 2-3% of children have an intellectual disability, and about 15% of children present with differences consistent with an intellectual disability (ie, global developmental delay and borderline intellectual functioning). In this Review, we discuss the prevalence of mental health problems, interventions to address these, and issues of access to treatment and services. Where possible, we take a global perspective, given most children with intellectual disability live in low-income and middle-income countries. Approximately 40% of children with intellectual disability present with a diagnosable mental disorder, a rate that is at least double that in children without intellectual disability. Most risk factors for poor mental health and barriers to accessing support are not unique to people with intellectual disability. With proportionate universalism as the guiding principle for reducing poor mental health at scale, we discuss four directions for addressing the mental health inequity in intellectual disability.

Effects of exercise training on obesity-related parameters in people with intellectual disabilities: systematic review and meta-analysis

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.

Research on Effective Strategies of College Physical Education Interactive Teaching Based on Machine Learning

To master physical education courses, you must master a complete set of skills and knowledge. Most teachers still adopt traditional teaching forms, teacher centered, which has a negative impact on students. Because learners only passively participate in activities, it reduces students' enthusiasm and focus to master skills. This study is aimed at comparing and contrasting the differences between modern interactive learning and traditional teaching strategies. We collect qualitative and quantitative results about the impact of these studies on students' communication skills and understanding of relevant topics. The form of the noninteractive learning strategies explored in this study is the teaching system. This is a commonly used method and is still used in some institutions. Its limitations have led to the modernization of the education sector, especially in sports. This modernization brings about other forms of physical education, being student centered and more interactive. This form of interaction promotes the connection between teachers and students and promotes the transmission of feedback and the continuous improvement and novelty of activity forms. The interactive approach used in this study is the brainstorming method. Research has found it to generate constructive ideas and ideas. The specific process includes case study and Q & A, which is intuitive and clear, and can enhance the comprehensive understanding of the theme. The modernization of physical education curriculum brings many benefits; some of which will be listed in this paper. This study is aimed at promoting more display of students' personality in modern physical education teaching with clear research conclusions. Let the students in the training interact with teachers and interact with the group, in the interaction to play their own greater initiative, enthusiasm. Let the relationship between students and teachers be more harmonious, and let the students' physical quality get better development.

Neural Effects of Physical Activity and Movement Interventions in Individuals With Developmental Disabilities-A Systematic Review

Individuals with developmental disabilities present with perceptuo-motor, social communication, and cognitive impairments that often relate to underlying atypical brain structure and functioning. Physical activity/movement interventions improve behavioral performance of individuals with and without developmental disabilities. Majority of the evidence on potential neural mechanisms explaining the impact of physical activity/movement interventions is based on studies in individuals with typical development; there is a dearth of systematic reviews synthesizing the neural effects of physical activity/movement interventions in individuals with developmental disabilities. In this systematic review, we have gathered evidence on the neural effects of physical activity/movement interventions from 32 papers reporting substantial neural effects and behavioral improvements in individuals with developmental disabilities. Chronic intervention effects (multiple sessions) were greater than acute intervention effects (single session). Specifically, using electroencephalogram, functional magnetic resonance imaging, diffusion tensor imaging, and functional near-infrared spectroscopy, studies found physical activity/movement intervention-related changes in neural activity, indicating normalization of cortical arousal in individuals with attention-deficit /hyperactivity disorder (ADHD), increased social brain connectivity in individuals with autism spectrum disorder (ASD), and more efficient executive functioning processes in individuals with a wide range of other developmental disabilities. Despite promising results, more research is clearly needed in this area with larger sample sizes, using standardized neuroimaging tools/variables, and across multiple diagnoses to further explore the neural mechanisms underlying physical activity/movement interventions and to replicate findings from the present review.

COVID-19 Pandemic and Individuals With Intellectual Disability: Special Olympics as an Example of Organizational Responses and Challenges

The COVID-19 pandemic is a worldwide crisis. It has been, and is, an extreme challenge for our health care and prevention systems, and for society as a whole. Among many facets of life, physical activity and sport has been heavily impacted. The aim of this viewpoint article is to highlight the effect of the COVID-19 pandemic on individuals with an intellectual disability, with a particular focus on physical activity and Special Olympics. Specific objectives are (a) to share what the literature reveals about the impact of COVID-19 on the health and well-being of individuals with an intellectual disability, (b) to examine what is known about the impact of the pandemic on physical activity of individuals with an intellectual disability, (c) to describe Special Olympics program responses during the pandemic, and (d) to recommend areas for future research.

Physical activity levels of children and adolescents with intellectual disabilities in Northern China

BACKGROUND

Limited research has looked at the physical activity (PA) among Chinese children and adolescents with intellectual disabilities.

METHODS

The Children's Leisure Activities Study Survey-Chinese version was applied in evaluating PA levels among children and adolescents with intellectual disabilities.

RESULTS

The data indicated that only 29.5% of children and adolescents with intellectual disabilities met the PA recommendation. Boys engaged in significantly more MVPA and had higher energy expenditure than girls during weekdays and the whole week. The general trend in PA levels demonstrated a downtrend with the growth of age of children and adolescents with intellectual disabilities. The students aged 6-12 years old performed more MVPA and had greater energy expenditure compared with those 13-15 and 16-18 years old.

CONCLUSION

The level of PA among Chinese children and youths with intellectual disabilities is remarkably low, and there is a large gap compared with the PA recommendation.

The Impact of Physical Education Classes on Health and Quality of Life during the COVID-19

The purpose of this study was to examine the effects of the COVID-19 pandemic on the well-being and the quality of life of college students participating in physical education classes. We consider this study to be relevant because during the COVID-19 pandemic we tested whether the boost in effective activity among physical education class participants affected well-being and quality of life. A sectional questionnaire survey was conducted across Taiwan in 2019–2020. Data were collected in two stages within 6 months from a sample of 1011 university students in Taiwan (328 male, 683 female). A series of one-way ANOVAs was adopted to examine each outcome across groups and time phases. The results provide support for a positive relationship between well-being (β = 0.25, p < 0.001), and quality of life (β = 0.92, p < 0.001), supporting our expectations. Findings from our study suggest that physical activity was positively associated with mental health; and participation in physical activity had an effect on the well-being and quality of life in college students.

Comparison of Lower and Upper Quarter Y Balance Test Performance in Adolescent Students with Borderline Intellectual Functioning Compared to Age- and Sex-Matched Controls

The Lower (YBT-LQ) and Upper (YBT-UQ) Quarter Y Balance Test are well established assessment tools for the examination of dynamic balance and shoulder mobility/stability, respectively. However, investigations on YBT-LQ/UQ performance in students with borderline intellectual functioning (BIF) (i.e., intelligence quotient of 70–84 etc.) are lacking. Thus, the aim of the study was to compare YBT-LQ/UQ performance in students with and without BIF. Thirty students with BIF (age: 13.7 ± 1.2 years) and 30 age-/sex-matched students without BIF (age: 13.7 ± 1.3 years) performed the YBT-LQ and/or YBT-UQ. Normalized maximal reach distances (% leg/arm length) per reach direction and the composite score were used as outcome measures. A univariate analysis of variance was conducted to test for significant group differences. Irrespective of limb and reach direction, students with BIF compared to those without BIF showed significantly worse YBT-LQ (p ≤ 0.001–0.031; Cohen’s d = 0.57–1.26) and YBT-UQ (p ≤ 0.001–0.015; Cohen’s d = 0.68–1.52) performance with moderate to large effect sizes. Due to the poorer performance levels of students with BIF, specifically tailored interventions should be developed that have the potential to improve their dynamic balance and shoulder mobility/stability.

The association between physical activity and mental health in children with special educational needs: A systematic review

The association between physical activity (PA) and mental health in typically developing children has been amply documented, but little is known about the corresponding association in children with special educational needs (SEN). This systematic review aimed to synthesize the evidence for the association between PA and mental health in children with SEN. A systematic literature search of five databases (PsycINFO, SPORTDiscus, PubMed, Web of Science, and CINAHL) was conducted, and the publication year was between October 2010 and February 2021. Two researchers performed abstract and full text screening and extracted the data independently. Inclusion and exclusion criteria followed the PICOS framework, and the quality of eligible studies was assessed using the McMaster critical review form. Eighteen studies that met the inclusion criteria and had quality ratings ≥ 60% were included in this review. PA was positively associated with overall psychological well-being and its subtypes (including enjoyment, self-worth, self-competence, mental wellness, and quality of life), and negatively associated with anxiety and fatigue. Body composition, age, and sex were moderators of the association. The findings of this review indicated that PA was consistently associated with mental health in children with SEN. These associations were the most powerful when PA was conducted in unstructured types such as free play and recess activities. Structured types including physical education classes were more strongly related to mental health than overall PA (combined structured and unstructured types). Future PA interventions are needed to promote mental health in children with SEN.

Effects of Exercise Programs on Anxiety in Individuals with Disabilities: A Systematic Review with a Meta-Analysis

Anxiety symptoms are increasingly prevalent in individuals and may affect their quality of life. Physical exercise (PE) has been shown to be an effective method for reducing anxiety symptoms in the general population. The present study aimed to identify if PE programs can be a good method to reduce anxiety symptoms in individuals with disabilities, through the methodology of a systematic review with a meta-analysis. The PubMed, Web of Science, Scopus, and SPORTDiscus databases were used, considering the period from 2001 to 2021. The descriptors used were: “cerebral palsy”, “motor disability”, “physical disability”, “vision impairment”, “visual impairment”, “vision disability”, “intellectual disability”, “mental retardation”, “intellectual disabilities”, “hearing impairment”, “hearing disability”, “multiple disabilities”, “physical activity”, “exercise”, “sport”, “training”, and “anxiety”, with the Boolean operator “AND” or “OR”. The systematic review with a meta-analysis was carried out in the period between May and June 2021. The Z values (Z-values) obtained to test the null hypothesis, according to which the difference between means is zero, demonstrated a Z = 2.957, and a corresponding p-value of 0.003. Thus, we can reject the null hypothesis, and affirm that PE promotes positive effects and can be a good method or methodology for the reduction of anxiety symptoms of individuals with disabilities.

Effects of a Floor Hockey Intervention on Motor Proficiency, Physical Fitness, and Adaptive Development in Youths with Mild Intellectual Disabilities

This study examined the effects of a 12-week floor hockey training program on the motor proficiency, physical fitness, and adaptive development of youths with mild intellectual disabilities (IDs). A total of 54 youths with IDs were divided into two groups: a floor hockey exercise group (EG; n = 27; age, 16.59 ± 0.56 years) and a control group (CG; n = 27; age, 16.65 ± 0.63 years). The participants in the EG attended sessions of a floor hockey training program 3 times per week over a 12-week period. The CG group maintained their standard activities of daily living. The participants' scores on the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition, Brockport Physical Fitness Test, and traditional Chinese version of the teacher form of the Adaptive Behavior Assessment System, Second Edition, were obtained before and after the intervention. The results of the study indicate that the 12-week floor hockey training program significantly increased the participants' scores for most indicators of motor proficiency (p < 0.01), physical fitness (p < 0.01), and adaptive development (p < 0.01). The findings provide evidence that physical activity interventions focusing on floor hockey training are a viable therapeutic option for treating youths with IDs.

Feasibility of a school-based physical activity intervention for adolescents with disability

BACKGROUND

Adolescents with disability are less active and have lower levels of physical fitness than their typically developing peers. Schools are ideal settings to address this; however, few school-based interventions have been designed and evaluated among this group. Therefore, the aim of this pilot study was to determine the feasibility of a time-efficient school-based physical activity intervention for adolescents with disability.

METHODS

A non-randomized pilot trial was conducted with adolescents in the special education unit at one secondary school in New South Wales, Australia. Sixteen grade 11 and 12 students (aged 17.3 ± 0.7 years) participated in the 2-month physical activity intervention. Two classroom teachers were trained to facilitate the delivery of a high-intensity interval training (HIIT) program, known as Burn 2 Learn adapted (B2La). Teachers were asked to deliver 2-3 weekly HIIT sessions for a period of 2 months. Four domains of feasibility (acceptability, implementation, adaptability, and practicality) were assessed using quantitative measures at the student and teacher levels (e.g., observations, process evaluation questionnaires, and heart rate [HR] monitoring). Data were also collected from three learning and support teachers who assisted classroom teachers with intervention delivery. Preliminary efficacy of the intervention on measures of adolescents' functional capacity (6-min walk/run test) and muscular fitness (sit-to-stand test and modified push-up test) were analyzed using paired sample t-tests.

RESULTS

Moderate-to-high levels of program satisfaction were reported by both students (80% rated "Good" or "Excellent") and teachers (100% rated "Good" or "Excellent"). Teachers reported delivering 2.5 ± 0.7 sessions per week during the study. Based on researcher session observations, the program was delivered effectively by teachers (14/20). However, HR data indicated session intensity was lower than intended. The program was considered "adaptable" by teachers, with several observed modifications to HIIT sessions to cater for the needs of adolescents with disability. No adverse events were reported. We observed improvements in preliminary efficacy measures.

CONCLUSIONS

Our findings suggest it is feasible to train teachers to deliver a school-based HIIT program for adolescents with disability. Evaluation of B2La within a larger-scale effectiveness trial is warranted.

TRIAL REGISTRATION

ACTRN12621000219886 .