Low Levels of Physical Activity and Sedentary Behavior in Adults with Intellectual Disabilities

Examining sedentary behaviours of adults with intellectual disabilities: A qualitative analysis

Sedentary behaviours among adults with intellectual disabilities have not been well studied. A sedentary lifestyle puts adults with and without disabilities at high risk of developing health conditions and diseases. Current literature revealed few empirical studies on the benefits of reducing sedentary behaviours with respect to the health of adults with intellectual disabilities. This research explored the factors that helped or hindered sedentary behaviours of adults with intellectual disabilities in the Canadian population. Guided by the socio-ecological model, Critical Incident Technique (CIT) was conducted. Five adults with intellectual disabilities from the Province of Ontario were interviewed and 102 critical incidents were collected. Adults with intellectual disabilities identified personal and environmental related factors that led to increased sedentary behaviours; and revealed helpful factors and wish-lists of actions that decreased sedentary lifestyle. Findings may be useful when developing programs aimed to decrease prolonged periods of sedentary behaviours specific to this vulnerable population.

Effect of Yoga of Adaptive Yogasana Practice on the Flexibility and Psychomotor Variables in Intellectually Disabled Subjects

Intellectual disability (ID) is a public health challenge affecting communities worldwide. ID is characterized by impaired physical and cognitive functioning and less engaged in physical activities. The objective of this study was to assess the impact of adaptive yoga practices on cognitive and motor abilities in the subjects with ID. Sixty-six subjects with mild and moderate IDs were purposively selected and randomly divided into experimental and control groups, with 33 subjects in each group. One month of adaptive yoga module was provided to the experimental group. To assess the impact of the yoga intervention, Functional Reach Test (FRT), Wall Toss Test (WTT), Finger Tapping Test (FTT), Sit-Reach Test (SRT), and Six Letter Cancellation Test (SLCT) were administered. The experimental group showed a statistically significant improvement with P < 0.05 across all the parameters, whereas the control group could not observe a significant improvement. Based on the results, this study concludes that "one month of adaptive yoga module" delivered impact and helped to improve the dynamic balance, eye-hand coordination, neuro-motor function, spinal flexibility, and selective attention in ID-afflicted subjects.

Differences in physical activity volume and intensity between Unified and non-Unified Special Olympics football training: An observational pilot study

BACKGROUND

The participation of people with intellectual disabilities in Special Olympics sports and training opportunities offers numerous benefits for health and inclusion. However, little is known about the impact of such training on physical activity behaviour. Here, we evaluate the differences in physical activity volume and intensity of Special Olympics athletes between Unified and non-Unified football training.

METHOD

Accelerometer data of 12 male athletes from eight standardised training sessions (four Unified, four non-Unified) were analysed.

RESULTS

While there was no statistically significant difference for the main part of the training, athletes showed higher levels of physical activity intensity (MVPA: Mdiff  = 11.74%; 95% CI = 5.50-17.97) and volume (average acceleration ENMO: Mdiff  = 112.82 mg; 95% CI = 24.73-200.90) in a Unified compared to non-Unified endurance-related exercise task.

CONCLUSION

Understanding physical activity participation in different training types can help to design and implement future training programmes.

A longitudinal exploration of self-reported TV behaviours as a surrogate for sedentary behaviour in older adults with an intellectual disability from the intellectual disability supplement to the Irish longitudinal study on aging (IDS-TILDA) study

This study presents the findings of an investigation into the self-reported TV habits of adults with an intellectual disability, where time watching TV was used as a proxy for sedentary behaviour (SB). Risk factors identified for the general and intellectual disability populations and standard covariates of age, sex, level of intellectual disability, living circumstances and BMI were explored to determine their viability as contributors to increased TV viewing and SB. Missing data was imputed using Multiple Imputation Chained Equation (MICE). Multinomial logistic regression and Chi-squared Automatic Interaction Detector Analysis (CHAID) analyses of risk factors for increased TV viewing were explored and compared. The Systems of Sedentary Behaviour (SOS) framework was used to structure results. Novel risk factors for increased TV viewing were identified.

Analysis of sedentary behaviour levels and patterns in adults with Down syndrome

BACKGROUND

Sedentary behaviour (SB) among adults with Down syndrome (DS) may differ based on personal or environmental factors.

OBJECTIVE

Investigate differences in SB levels and patterns of adults with DS based on sex, age, and residence-type across weekdays and weekends.

METHODS

Thirty-four adults with DS (15 men; 37 ± 12 years) underwent accelerometry-based measurements of sedentary time, bouts, and breaks for 7 days. We evaluated differences with 2 × 2 mixed-model (group-by-day) ANOVA.

RESULTS

Younger (19-36 years) individuals had less sedentary time (p = .042), and shorter (p = .048) and fewer (p = .012) bouts than older (37-60 years) individuals. Group home residents had more bouts on weekends than adults living with parent/guardians (p = .015).

CONCLUSIONS

Adults with DS spent half their waking hours in SB of short bouts. Age and residence may influence SB.

Individual, interpersonal and environmental correlates of sedentary behaviours in adults with intellectual disabilities

BACKGROUND

Sedentary behaviours have adverse health outcomes and adults with intellectual disabilities are at a higher risk of unhealthy lifestyle behaviours. The lack of knowledge relating to sedentary behaviours in adults with intellectual disabilities has impeded the development of effective interventions. This study aimed to investigate individual, interpersonal and environmental correlates that are associated with sedentary behaviours in adults with intellectual disabilities.

METHOD

A secondary analysis of data from The UK Household Longitudinal Study (Understanding Society; collected 2011-2013) was conducted. Twenty-two predictor variables were included in a stepwise logistic regression, with TV hours during weekdays (≤3 and >3 h/day) used as a proxy for sedentary behaviours. A sample of 266 adults, with mean age of 37.9 and range from 18 to 49 years old, with intellectual disabilities were identified. Because 63.9% were female, 62.4% had children and 28.2% were employed, the sample is likely to be most representative of more able adults with intellectual disabilities.

RESULTS

A significant interaction term between having children and neighbourhood status was found in the initial model so separate models for good and poor-quality neighbourhoods are reported. Having children only had a significant effect to lower the odds of high TV time among participants living in good quality neighbourhoods (OR 0.10, 95% CI 0.03, 0.25). However, for people living in poor quality neighbourhoods it was better quality leisure services that was associated with lower odds of high TV time (OR 0.48, 95% CI 0.23, 0.90). Being employed only significantly reduced the odds of high TV time in the good quality neighbourhood model (OR 0.35, 95% CI 0.12, 0.78). These effects highlight the importance of environmental effects on lifestyle behaviours of adults with intellectual disabilities.

CONCLUSIONS

Future research should aim to expand our understanding of environmental effects on the sedentary behaviours and other lifestyle behaviours of adults with intellectual disabilities.

Organized physical activity and sedentary behaviors in children and adolescents with autism spectrum disorder, cerebral palsy, and intellectual disability

BACKGROUND

There is little data on physical activity (PA), organized PA (OPA), and sedentary behaviors in autism spectrum disorders (ASD) and other neurodevelopmental disorders in developing countries.

AIM

To examine OPA, non-OPA, and sedentary behaviors and their associated factors in children and adolescents with ASD, cerebral palsy (CP), and intellectual disability (ID).

METHODS

A total of 1020 children and adolescents with ASD, CP, and ID were assessed regarding the child and family information as well as the Children's Leisure Activities Study Survey.

RESULTS

The results showed that the OPA level was significantly lower than non-OPA in all groups. Furthermore, the OPA level was significantly lower in the CP group compared to ASD and ID groups (P < 0.001). Also, moderate (P < 0.001), vigorous (P < 0.05), and total (P < 0.001) physical activity levels were significantly different between all three groups, with the values being higher in the ASD group compared to the other two. The mean of the total sedentary behavior duration in the ASD group (1819.4 min/week, SD: 1680) was significantly lower than in the CP group (2687 min/week, SD: 2673) (P = 0.007) but not ID group (2176 min/week, SD: 2168.9) (P = 0.525).

CONCLUSION

Our findings remark on the participation rate of PA, OPA, and sedentary behaviors of children and adolescents with ASD, CP, and ID in a developing country. In contrast, the need for developing standards of PA/OPA participation in neurodevelopmental disorders is discussed.

Examining the Canadian 24-Hour Movement Guidelines among Adults with Intellectual Disability: A Pilot Study

The purpose of this pilot study was to investigate the extent to which adults with intellectual disability (ID) met the 2020 Canadian 24-Hour Movement Guidelines. Fifteen adults (six females and nine males) participated in this nine-day observational study (age = 20-64 years) in 2021-2022, during the COVID-19 pandemic. Moderate-to-vigorous physical activity (MVPA), sedentary time, and total sleep time were measured with a smartwatch to compare to the guidelines. A diary subjectively tracked physical activity. Of the 15 participants, 11 met the MVPA guidelines (73%), 4 met the sedentary behaviour guidelines (27%), 7 met the sleep guidelines (47%), and only 1 participant met all 3 of the guidelines (7%). There were no differences in physical activity or sleep between weekends and weekdays, or between males and females. Walking, cleaning dishes, and swimming were the most common types of physical activity performed by the participants. The findings of this pilot study indicate the need to improve sleep and reduce sedentary time in adults with ID. As most participants met the MVPA guidelines, few met the sedentary behaviour guidelines, and nearly half met the sleep guidelines, these data also demonstrate how important it is to assess all three aspects of the movement guidelines. All these behaviours have independent health benefits and risks, which interact to influence overall health.

Anxiety, depression, and well-being in autistic adults and adults with other developmental disabilities: A longitudinal cross-lagged analysis

Autistic people and people with other developmental disabilities (DD) are at high likelihood for anxiety and depression, which can negatively affect adult life. Therefore, this study sought to understand temporal links between anxiety and depression over time in autistic adults and adults with DDs, and how these conditions impact specific aspects of positive well-being. A sample of 130 adults with autism or other DDs and their caregivers were drawn from a longitudinal study. Participants complete measures of anxiety (Adult Manifest Anxiety Scale), depression (Beck Depression Inventory, 2nd Edition), and well-being (Scales of Psychological Well-Being). Cross-lagged panel analyses revealed significant autoregressive effects for anxiety and depressive symptoms over time, based on both caregiver and self-report (all p < 0.01). Additionally, although findings differed across reporter, cross-lagged links between anxiety and depression emerged over time. Based on caregiver-report, anxiety symptoms predicted later depressive symptoms (p = 0.002) but depressive symptoms did not predict later anxiety (p = 0.10); the opposite pattern was identified for self-report. Aspects of positive well-being (purpose in life, self-acceptance, personal growth) demonstrated differential links with anxiety and depression (p = 0.001-0.53). These findings highlight the utility of a transdiagnostic approach to mental health services for autistic adults and adults with DDs, and the need to monitor for anxious or depressive symptoms in autistic adults and adults with DDs presenting with depression or anxiety, respectively.

Interprofessional Approach to Educate Health Care Students About Intellectual and Developmental Disabilities: Adaptive Communication and Physical Activity Planning

Introduction

People with intellectual and/or developmental disabilities (IDD) are a historically marginalized population and often require complex team-based health care services. Health care students receive little, if any, training about caring for this population. Improving training at the student level can improve health care quality for this population.

Methods

We developed a two-part interprofessional seminar series to increase students' knowledge, attitudes, and skills regarding caring for patients with IDD. The seminars were taught over Zoom and utilized presentation slides, prerecorded mock video interviews, and breakout room discussions focused on adaptive communication and developing adaptive physical activity plans for people with IDD. Participants comprised undergraduate and graduate students from various health care professional programs, including occupational therapy, medicine, and nursing.

Results

Part 1 had 208 participants, and part 2 had 107 participants. Both seminars were assessed using pre- and postsurveys that demonstrated increased participant comfort and confidence with the respective subjects. Competence of learned skills was not assessed. Participants in both seminars felt they would benefit from more direct interaction with people with IDD to practice learned skills.

Discussion

The results are encouraging for continued implementation at Quinnipiac University, with potential for use in other programs. Further iterations may include people with IDD serving as seminar cofacilitators, opportunities for students to directly interact with people with IDD, and use of an assessment approach evaluating learned skills competence. Curriculum expansion should cover the unique health care inequities faced by people with IDD who also belong to other marginalized groups.

How disability severity is associated with changes in physical activity and inactivity from adolescence to young adulthood

BACKGROUND

Disabilities may play a different role in determining people's physical activity (PA) and physical inactivity (PI) levels when they go through multiple lifetime transitions (e.g., graduation, marriage) between adolescence and young adulthood. This study investigates how disability severity is associated with changes in PA and PI engagement levels, focusing on adolescence and young adulthood, when the patterns of PA and PI are usually formed.

METHODS

The study employed data from Waves 1 (adolescence) and 4 (young adulthood) of the National Longitudinal Study of Adolescent Health, which covers a total of 15,701 subjects. We first categorized subjects into 4 disability groups: no, minimal, mild, or moderate/severe disability and/or limitation. We then calculated the differences in PA and PI engagement levels between Waves 1 and 4 at the individual level to measure how much the PA and PI levels of individuals changed between adolescence and young adulthood. Finally, we used two separate multinomial logistic regression models for PA and PI to investigate the relationships between disability severity and the changes in PA and PI engagement levels between the two periods after controlling for multiple demographic (age, race, sex) and socioeconomic (household income level, education level) variables.

RESULTS

We showed that individuals with minimal disabilities were more likely to decrease their PA levels during transitions from adolescence to young adulthood than those without disabilities. Our findings also revealed that individuals with moderate to severe disabilities tended to have higher PI levels than individuals without disabilities when they were young adults. Furthermore, we found that people above the poverty level were more likely to increase their PA levels to a certain degree compared to people in the group below or near the poverty level.

CONCLUSIONS

Our study partially indicates that individuals with disabilities are more vulnerable to unhealthy lifestyles due to a lack of PA engagement and increased PI time compared to people without disabilities. We recommend that health agencies at the state and federal levels allocate more resources for individuals with disabilities to mitigate health disparities between those with and without disabilities.

Pediatric Population with Down Syndrome: Obesity and the Risk of Cardiovascular Disease and Their Assessment Using Omics Techniques-Review

People with Down syndrome (PWDS) are more at risk for developing obesity, oxidative stress disorders, metabolic disorders, and lipid and carbohydrate profile disorders than the general population. The presence of an additional copy of genes on chromosome 21 (i.e., the superoxide dismutase 1 gene (SOD1) and gene coding for the cystathionine β-synthase (CBS) enzyme) raises the risk for cardiovascular disease (CVD). As a result of disorders in metabolic processes and biochemical pathways, theoretically protective factors (low homocysteine level, high SOD1 level) do not fulfil their original functions. Overexpression of the CBS gene leads to the accumulation of homocysteine-a CVD risk factor. An excessive amount of protective SOD1, in the case of a lack of compensatory increase in the activity of catalase and peroxidase, leads to intensifying free radical processes. The occurrence of metabolic disorders and the amplified effect of oxidative stress carries higher risk of exposure of people with DS to CVD. At present, classic predispositions are known, but it is necessary to identify early risk factors in order to be able to employ CVD and obesity prophylaxis. Detailed determination of the metabolic and lipid profile may provide insight into the molecular mechanisms underlying CVD.

Reference Values of Absolute and Relative Handgrip Strength in Chilean Schoolchildren with Intellectual Disabilities

Handgrip strength is a simple measure of general muscle strength and is related to functionality in people with intellectual disabilities. The objective of this research was to describe the normative values of absolute and relative handgrip strength in children, adolescents and adults according to sex. The sample was made up of 264 schoolchildren (n = 168 men) belonging to five special education schools in Santiago of Chile. The results show higher levels of absolute handgrip strength in males compared to females. The maximum peak of the absolute manual handgrip is reached in females in adolescence with a decrease in adulthood. Relative handgrip strength levels are similar in boys and girls. In females, the relative handgrip strength is similar in childhood and adolescence. Relative handgrip strength declines in both sexes from adolescence to adulthood. The reference values of this study can be used by professionals in the areas of health and education as a guide for interpretation, monitoring and follow-up of Chilean schooled people with intellectual disabilities.

Physical Activity and Physical and Mental Health in Middle-Aged Adults with Down Syndrome

Background

Adults with Down syndrome have an increased risk of aging-related physical and mental health conditions and experience them at an earlier age than the general population. There is a need to investigate modifiable lifestyle factors that may reduce risk for these conditions.

Method

The present study investigated the associations between physical activity (i.e., sedentary behavior and moderate-to-vigorous activity) assessed via accelerometer across 7 days and caregiver-reported physical and mental health of 66 non-demented middle-aged adults with Down Syndrome aged 25-55 years (52% female).

Results

Regression analyses indicated that more time spent in moderate intensity physical activity was associated with less risk of sleep apnea (b = -.031 p = .004) and endocrine/metabolic conditions (b = -.046 p = .009), and lower total number of physical health conditions (b = -.110 p =.016) and anxiety disorders (b = -.021 p =.049) after controlling for relevant sociodemographics. After also adjusting for BMI, the association between time spent in moderate intensity physical activity and sleep apnea (b=-.035, p = .002), endocrine/metabolic conditions (b=-.033, p = .045) and total physical health (b=-.091, p =.026) remained significant Unexpectedly, time spent in sedentary behavior was negatively associated with musculoskeletal conditions (b=-.017, p = .044).

Conclusion

Findings indicate important associations between physical activity in everyday life and the physical and mental health of adults with Down syndrome. Social policies and interventions aimed at reducing time spent sitting around (i.e., sedentary behavior) and encouraging moderate-to-vigorous activity may be a low-burden and low-cost mechanism for fostering healthy physical and mental aging in the Down syndrome population.

The Top 50 Most Cited Articles on Special Olympics: A Bibliometric Analysis

The Special Olympics was established in 1968 to "provide year-round sports training and athletic competition in a variety of Olympic-type sports for children and adults with intellectual disabilities". It has gained recognition in the field of sports and healthcare of persons with intellectual disability, with a large number of dedicated researchers and institutions all over the world. However, there is an urgent need to analyze the progress and current status of this research field to identify knowledge gaps and develop this discipline. The aim of this study was to analyze the scientific production of the Special Olympics and report the bibliometric characteristics of the top 50 most cited Special Olympics publications. A systematic search was conducted on the Scopus database and bibliometric data were extracted and analyzed. The top 50 publications received 1632 citations. A total of 138 authors (63 female and 75 male) contributed to these publications. The two main areas of study were the physical health of Special Olympics athletes (n = 27) and the psycho-social health of athletes (n = 12).

Sedentary behaviour levels in adults with an intellectual disability: a systematic review and meta-analysis

Background: Sedentary behaviour (SB), which is characterised by low levels of energy expenditure, has been linked to increased cardio-metabolic risks, obesity and mortality, as well as cancer risk. No firm guidelines are established on safe levels of SB. Adults with an intellectual disability (ID) have poorer health than their counterparts in the general population with higher rates of multi-morbidity, inactivity, and obesity. The reasons for this health disparity are unclear however it is known that SB and overall inactivity contribute to poorer health. There is no clear picture of the levels of SB among individuals with ID therefore SB levels in this vulnerable population need to be examined. The aim of this systematic review is to investigate the prevalence of sedentary behaviour in adults with an ID.  

Methods: The PRISMA-P framework was applied to identify high quality articles. An extensive search was carried out in four databases and grey literature sources . In total, 1,972 articles were retrieved of which 48 articles went forward for full review after duplicate removal and screening by title and abstract. The National Institute of Health’s quality assessment tools were used to assess article quality. Two reviewers independently assessed each article. An excel spreadsheet was created to guide the data extraction process. The final review included 25 articles. A meta-analysis was completed using REVMAN.  

Results: Different SB assessment types were identified in studies. These included steps, time, questionnaires, and screen time. Studies were heterogeneous. Observed daily steps per individual ranged from 44 to above 30,000, with an average of approximately 6,500 steps. Mean daily time spent in SBs was more than 60% of available time, with observed screen time of more than 3 hours. 

Conclusion: There is a high prevalence of SB in adults with an intellectual disability. 

 [Registration no: Index CRD42020177225].

Cardiovascular Physiology and Pathophysiology in Down Syndrome

Down Syndrome (Ds) is the most common chromosomal cause of intellectual disability that results from triplication of chromosome 21 genes. Individuals with Ds demonstrate cognitive deficits in addition to comorbidities including cardiac defects, pulmonary arterial hypertension (PAH), low blood pressure (BP), and differences in autonomic regulation. Many individuals with Ds are born with heart malformations and some can be surgically corrected. Lower BP at rest and in response to exercise and other stressors are a prevalent feature in Ds. These reduced cardiovascular responses may be due to underlying autonomic dysfunction and have been implicated in lower exercise/work capacity in Ds, which is an important correlate of morbidity, mortality and quality of life. Exercise therapy can be beneficial to normalize autonomic function and may help prevent the development of co-morbidities in Ds. We will review cardiovascular physiology and pathophysiology in individuals with Ds, along with exercise therapy and special considerations for these individuals.

Gaining actionable knowledge to improve local health-promoting capacities in long-term care support settings for people with intellectual disabilities

OBJECTIVE

People with intellectual disabilities (ID) are largely dependent on their environment to live healthily and, in this, ID-support organizations play a vital role. An environmental asset mapping tool for ID-support settings has been developed. This study aims to provide insight into whether or not the tool can provide a comprehensive view on assets in the system and actionable knowledge to improve health-promoting capacities in ID-support settings.

METHODS

Fifty-seven users from four setting completed the tool on availability, user satisfaction, and dreams regarding social, physical, organizational, and financial assets.

RESULTS

The findings provide a comprehensive view of available assets. Together with user satisfaction and dreams for improvements, they provide actionable knowledge for improving the health-promoting capacities of the settings, including: (1) how use of available assets can be improved, (2) the type of assets that should be enriched, and (3) the assets that can be added to the system.

CONCLUSION

The asset mapping tool provides a comprehensive view on assets in the system and actionable knowledge to improve health-promoting capacities in ID-support settings.

PRACTICE IMPLICATIONS

ID-support organizations can use the tool to generate actionable bottom-up knowledge for priority setting and implementing interventions to improve their health-promoting capacities.

Implementation of a program to support direct support professionals to promote a healthy lifestyle for people with moderate to profound intellectual disabilities

BACKGROUND

There is a lack of theory-based interventions for direct support professionals (DSPs) to support a healthy lifestyle for people with moderate to profound intellectual disabilities (ID) despite their major role in this. This study aims to evaluate the preparation, implementation, and preliminary outcomes of a theory-based training and education program for DSPs to learn how to support these individuals.

METHODS

The program consisting of e-learning, three in-person sessions, and three assignments was implemented. The implementation process was evaluated with a mixed method design with the following components: preparation phase, implementation phase, and the outcomes. These components were measured with project notes, questionnaires, interviews, reflections, assignments, food diaries, Actigraph/Actiwatch, and an inventory of daily activities.

RESULTS

Regarding the preparation phase, enough potential participants met the inclusion criteria and the time to recruit the participants was 9 months. The program was implemented in four (residential) facilities and involved individuals with moderate to profound ID (n = 24) and DSPs (n = 32). The e-learning was completed by 81% of the DSPs, 72-88% attended the in-person sessions, and 34-47% completed the assignments. Overall, the fidelity of the program was good. DSPs would recommend the program, although they were either negative or positive about the time investment. Mutual agreement on expectations were important for the acceptability and suitability of the program. For the outcomes, the goals of the program were achieved, and the attitudes of DSPs towards a healthy lifestyle were improved after 3 months of the program (nutrition: p = < 0.01; physical activity: p = 0.04). A statistically significant improvement was found for food intake of people with ID (p = 0.047); for physical activity, no statistically significant differences were determined.

CONCLUSIONS

The theory-based program consisting of a training and education section for DSPs to support a healthy lifestyle for people with moderate to profound ID was feasible to implement and, despite some barriers regarding time capacity and mutual expectations, it delivered positive changes in both persons with moderate to profound ID and DSPs. Thus, the program is a promising intervention to support DSPs.

Perceived Barriers of Physical Activity Participation in Individuals with Intellectual Disability-A Systematic Review

Individuals with intellectual disability (ID) tend to have a sedentary lifestyle, with low physical fitness and an increased risk of chronic diseases. One reason for the prevalence of a sedentary lifestyle is the existence of barriers to participation in physical activity (PA). The purpose of this systematic review is to update knowledge about the perceived barriers of PA participation in individuals with ID. Electronic searches were carried out in the PubMed, Scopus, SPORTDiscus and Web of Science databases, from September 2020 to May 2021, and included articles published between January 2016 and May 2021. The terms used were: "mental retardation", "intellectual disability", "intellectual disabilities", "physical activity", "motor activity", "barriers", "obstacles", "embarrassment" and "constraint", in combination with the Boolean operators "AND" or "OR". After the methodological process, five studies were included for analysis. These studies revealed the existence of several perceived barriers to regular PA participation, which were grouped into five main groups: personal (6 topics), family (4 topics), social (13 topics), financial (1 topic) and environmental (1 topic). The knowledge and identification of participation barriers can be of extreme importance both to institutions and professionals aiming to enhance the participation of individuals with ID in regular PA programs.

The LEDs move pilot study: the Light Curtain and physical activity and well-being among people with visual and intellectual disabilities

BACKGROUND

Moving around and being physically active can often be challenging for people with a visual impairment. The combination of a visual and intellectual disability can make being physically active even more difficult. The aim of the current study was to examine whether a technological device for physical activity promotion would be associated with more movement and whether using it would be experienced as enjoyable for people with visual and intellectual disabilities.

METHODS

A randomised multiple baseline design was used for this study. The participants were nine adults with a visual impairment and an IQ between 20 and 50. As participants interacted with the Light Curtain, movement was measured with triaxial accelerometers embedded in the Empatica E4 wristband. Independent observers scored activity, alertness and well-being from video-recordings using the following observation lists: the Happiness Feature Score (HFS) and the Arousal and Valence Scale (AVS).

RESULTS

Physical activity measured with the accelerometer and positive excitement measured with the AVS significantly increased among participants when they were engaged with the Light Curtain compared with care-as-usual activities. Well-being measured with the HFS did not show a significant difference between the baseline and intervention phases.

CONCLUSIONS

Engagement with the Light Curtain increased physical activity and positive excitement in persons with visual and intellectual disabilities, but more research is necessary to understand how the Light Curtain might affect happiness and well-being.

The Effects of Integrated Step Training into the Physical Education Curriculum of Children with Intellectual Disabilities

(1) Background: This study investigated the changes in step frequency, walking ability, and standing posture of students with intellectual disabilities by integrating step training into the students' physical education curriculum; (2) Methods: The centroid formula was used to estimate the geometric center of the students' bodies in video footage of each participant. Each participant's stepping frequency per minute was recorded. After training, the teachers involved were interviewed regarding the participants' everyday activities in school. Each step training session was recorded by two video cameras. Each step training session was observed and photographed by a senior physical education teacher with special education qualifications; (3) Results: The step training increased the stability of the participants' body axes. The participants' average steps per minute of the participants significantly improved from 24.200 ± 7.554 to 28.700 ± 8.629. Additionally, despite the students exhibiting anxious behavior (e.g., squeezing their hands and grasping at their clothes) at baseline, the frequency of these behaviors decreased significantly from week 4. Overall, the students' daily activities, motivation, interpersonal interaction, self-confidence, and anxiety behaviors improved; (4) Conclusions: After the 8-week step program, the participants with intellectual disabilities improved their step frequency, movement stability, ability to perform daily activities, walking speed, motivation, interpersonal interaction, and self-confidence, and they exhibited a lower level of anxiety-related behaviors.

Investigation of the effects of physical education activities on motor skills and quality of life in children with intellectual disability

Aim: This study was carried out in order to examine whether there is a difference between the quality of life and motor skills of children with intellectual disability who participate in physical education activities and those who do not participate. Method: This study was conducted with a total of 34 children with 16 children in the control group (8 girls, 8 boys) and 18 children in the experimental group (11 boys, 7 girls) using a pre-test, post-test and control group experimental design. A 14-week "Physical Education Activities Program" was applied to the children in the experimental group. Children in the control group did not participate in physical education activities. The Bruininks Oseretsky test of motor proficiency second edition brief form 2010 to measure the motor performance and "Pediatric Quality of Life Inventory (PedsQL)" developed by Varni et al. in 1999 were used for children with intellectual disability. Findings: When the motor skill tests of the children with intellectual disability in the experimental group were evaluated, significant improvements were found in fine motor precision, fine motor integration, manual dexterity, bilateral coordination, balance, speed and agility, upper limb coordination, strength tests and all dimension scores for quality of life compared to the pre-test (p < 0.05). In the control group, a statistically significant improvement was observed in the quality of life Physical Functioning score and fine motor integration, bilateral coordination, and upper limb coordination tests (p < 0.05). More significant improvement was observed in motor skills and quality of life in children with intellectual disability who participated in the 14-week physical education program compared to the control group. Conclusion: Physical education activities contributed positively to improving the motor skills and quality of life of children with intellectual disability.

Sedentary behaviour levels in adults with an intellectual disability: a systematic review and meta-analysis

Background: Sedentary behaviour (SB), which is characterised by low levels of energy expenditure, has been linked to increased cardio-metabolic risks, obesity and mortality, as well as cancer risk. No firm guidelines are established on safe levels of SB. Adults with an intellectual disability (ID) have poorer health than their counterparts in the general population with higher rates of multi-morbidity, inactivity, and obesity. The reasons for this health disparity are unclear however it is known that SB and overall inactivity contribute to poorer health. There is no clear picture of the levels of SB among individuals with ID therefore SB levels in this vulnerable population need to be examined. The aim of this systematic review is to investigate the prevalence of sedentary behaviour in adults with an ID.   Methods: The PRISMA-P framework was applied to identify high quality articles. An extensive search was carried out in four databases and grey literature sources . In total, 1,972 articles were retrieved of which 48 articles went forward for full review after duplicate removal and screening by title and abstract. The National Institute of Health's quality assessment tools were used to assess article quality. Two reviewers independently assessed each article. An excel spreadsheet was created to guide the data extraction process. The final review included 25 articles. A meta-analysis was completed using REVMAN.   Results: Different SB assessment types were identified in studies. These included steps, time, questionnaires, and screen time. Studies were heterogeneous. Observed daily steps per individual ranged from 44 to above 30,000, with an average of approximately 6,500 steps. Mean daily time spent in SBs was more than 60% of available time, with observed screen time of more than 3 hours.  Conclusion: There is a high prevalence of SB in adults with an intellectual disability.   [Registration no: Index CRD42020177225].

Sedentary behaviour levels in adults with an intellectual disability: a systematic review and meta-analysis

Background: Sedentary behaviour (SB), which is characterised by low levels of energy expenditure, has been linked to increased cardio-metabolic risks, obesity and mortality, as well as cancer risk. No firm guidelines are established on safe levels of SB. Adults with an intellectual disability (ID) have poorer health than their counterparts in the general population with higher rates of multi-morbidity, inactivity, and obesity. The reasons for this health disparity are unclear however it is known that SB and overall inactivity contribute to poorer health. There is no clear picture of the levels of SB among individuals with ID therefore SB levels in this vulnerable population need to be examined. The aim of this systematic review is to investigate the prevalence of sedentary behaviour in adults with an ID.   Methods: The PRISMA-P framework was applied to identify high quality articles. An extensive search was carried out in four databases and grey literature sources . In total, 1,972 articles were retrieved of which 48 articles went forward for full review after duplicate removal and screening by title and abstract. The National Institute of Health's quality assessment tools were used to assess article quality. Two reviewers independently assessed each article. An excel spreadsheet was created to guide the data extraction process. The final review included 25 articles. A meta-analysis was completed using REVMAN.   Results: Different SB assessment types were identified in studies. These included steps, time, questionnaires, and screen time. Studies were heterogeneous. Observed daily steps per individual ranged from 44 to above 30,000, with an average of approximately 6,500 steps. Mean daily time spent in SBs was more than 60% of available time, with observed screen time of more than 3 hours.  Conclusion: There is a high prevalence of SB in adults with an intellectual disability.   [Registration no: Index CRD42020177225].

Designing User-Centered Mobile Health Initiatives to Promote Healthy Behaviors for Children With Disabilities: Development and Usability Study

Background

The gap between research and its practical application in community settings limits its impact on public health. Closing this gap has the potential to improve the well-being of underserved groups, such as children with disabilities. Mobile health has the potential to improve access to community resources and support for underserved populations, thereby encouraging improved health behaviors.

Objective

In this feasibility pilot study, we describe the development of the mobile app Jooay. Jooay was developed in partnership with stakeholders to facilitate access to leisure and physical activity community programs for children and youth with disabilities. We also reflect on the lessons learned throughout the implementation process that are relevant for improving the health behaviors of children with disabilities.

Methods

We used a participatory action research approach to develop the app. We also administered a survey to current Jooay users and analyzed various app usage indicators to explore use patterns, user feedback, and preferences. Finally, we critically appraised the implementation process through a best practices for implementation research framework.

Results

We developed a product that responds to users’ identified need to find information and follows accessibility and user-centered design standards. The analysis of usage data revealed that access to the Jooay app is concentrated in urban areas. Perceptions, attitudes, and information needs varied according to the type of user. The use of the mobile app changed over time, and usage decreased after the app was downloaded, indicating a need for the sustained engagement of app users. Users found value in the ability to identify activities that they would not otherwise know about. However, app use alone was not sufficient to improve participation. Although the app was developed based on users’ active input in multiple iterations, we encountered challenges with survey recruitment and attrition, suggesting the need for more seamless and engaging means for collecting data within this population.

Conclusions

Interactions between users and the app can sustain user engagement and behavior change. We will improve the app’s next iterations by using the information gained from this study to conduct a larger study to assess the relationship among social and material deprivation, urban design, and access to inclusive and adaptive leisure programs. This study will inform the improvement of app listings to improve the use of Jooay by different user groups and promote health through mobile apps for marginalized groups.

Health-promotion intervention in a group home: Perspectives of residents, staff and rehabilitation professionals

Promoting healthier lifestyles in people with intellectual disabilities is important in order to improve health and reduce health inequalities. Few studies have explored how health-promotion interventions for people with intellectual disabilities in community-based settings are experienced. The aim of this study was to explore residents', staff members' and rehabilitation professionals' experiences of how a health-promotion intervention affected the habits of people living in a group home regarding eating habits and physical activities and staffs' ways of working. Semi-structured group interviews were conducted with five residents, six staff members and five rehabilitation professionals. The group discussions were analysed with content analysis separately for each group. Four different categories described residents', staff members' and rehabilitation professionals' views respectively. It is suggested that including people with intellectual disabilities as active parties throughout the process would facilitate implementation of a health-promotion profile in community residences.

Demonstrating the vital role of physiatry throughout the health care continuum: Lessons learned from impacts of the COVID-19 pandemic on the disability community

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Physical activity correlates in children and adolescents, adults, and older adults with an intellectual disability: a systematic review

PURPOSE

Understanding enablers of and barriers for physical activity (PA) participation in people with intellectual disability (ID) is an essential first step to develop effective interventions. This systematic review examined correlates of PA across the socio-ecological model (i.e., intra-personal, inter-personal, environmental and policy level) in people with ID across the lifespan.

MATERIAL AND METHODS

Major electronic databases were searched from inception until 15 February 2021. Keywords included "physical activity" or "exercise" and "intellectual disability" or "mental retardation." A summary coding was used to analyze the data for adolescents (<18 years), adults (18 < 50 years), and older adults (50≤ years).

RESULTS

Out of 83 PA correlates, retrieved from 39 studies (n = 26,456), only three consistent (i.e., reported in four or more studies) correlates were identified. In adults, older age (7/11, 64%), more severe ID (9/9, 100%) and the presence of physical mobility problems (3/4, 75%) were associated with decreased PA. From 38 correlates identified, no consistent correlates were identified for children and adolescents and older people.

CONCLUSIONS

Despite the abundance of evidence of the PA benefits for people with ID, we only found consistent evidence for three correlates reliably being related to PA in adults with ID. More research, particularly among young and older people is urgently needed.IMPLICATIONS FOR REHABILITATIONMore severe intellectual disability is an important barrier for being active in adults with intellectual disability.Presence of physical health problems is an important barrier for being active in adults with intellectual disability.

Effects of exercise interventions on frailty in pre-maturely aging adults with intellectual disabilities- a preliminary study

BACKGROUND

Effects of exercise interventions targeting frail adults with intellectual disabilities (ID) are unknown.

OBJECTIVE

This study compared the effects of a combined exercise, walking programs and no intervention on frailty and muscle mass in adults with ID and pre-frail or frail conditions.

METHODS

This study was a quasi-experimental design, with 103 adults from six residential care and day-care centers in southern Taiwan completing study participation. A 10-week combined exercise and walking program were administered to the experimental (n = 36) and comparison (n = 32) groups respectively, with no intervention provided to the control group (n = 35). A questionnaire, measurements of frailty phenotype and a body composition machine were used to collect data. Descriptive statistics, chi-squared test, ANOVA and repeated measure ANOVA tests were conducted in the Chinese IBM SPSS 20.0.

RESULTS

Significant differences on level of frailty among the three groups were revealed after interventions. Mean differences of muscle mass demonstrated significant changes between baseline and after interventions, although improvements of frailty score between baseline and after interventions were not significant.

CONCLUSIONS

Our preliminary findings demonstrated the tendency of positive effects of combined exercise or walking programs in improving level of frailty and muscle mass in adults with ID. Early implementation of exercise interventions might be beneficial for prematurely aging adults with ID.

Static postural balance between male athletes with intellectual disabilities and their sedentary peers: A comparative study

BACKGROUND

Previous reports showed that athletes without disabilities have better postural skills than their sedentary peers. This finding has not been elucidated in athletes with intellectual disabilities despite their decreased postural balance. This study aims to investigate static postural balance in track and field athletes with intellectual disabilities compared to their sedentary peers.

METHODS

Eighteen track and field athletes with intellectual disabilities (23.5 ± 4.52 years) and 18 sedentary peers (20.3 ± 3.4 years) participated in this study. A stabilometric platform was used to assess static postural balance in bipedal and unipedal stances with open (OE) and closed (CE) eyes.

RESULTS

In OE, the result showed significantly better static postural balance (CoP_Vm : p < .001; CoP_area : p < .001) in athletes compared to the sedentary ones in both stances. In CE, this difference was not observed in the unipedal stance.

CONCLUSION

Track and field experience may improve static postural balance in athletes with intellectual disabilities, mainly when visual input is available.

Levels and patterns of sedentary behavior in men and women with intellectual disability

BACKGROUND

There are limited data on the levels and patterns of sedentary behavior (SB) among U.S. adults with ID.

OBJECTIVE

To examine SB levels and patterns in U.S. adults with ID and how these differ between sexes, age-groups, and week vs. weekend days.

METHODS

Fifty-two adults with ID (25 men; age 45 ± 14 years) wore a hip accelerometer (wGT3X-BT; Actigraph) during the waking hours for 7 days. We determined total sedentary time, percent of wear time spent sedentary bouts ≥1, ≥10, ≥30, and ≥60 min, and breaks in sedentary time for bouts ≥10 min. We examined differences in SB variables as a function of sex, age-group by median split (≤48 vs. >48 years), and day of the week.

RESULTS

Total sedentary time was 514 ± 139 min · day^-1 accumulated in bouts 1-30 min and did not differ between sexes or age-groups. Bouts ≥1 min across days were longer for men than women and longer during weekend days than weekdays (p < 0.05). The number of bouts ≥1 min was greater during weekdays than weekend days (p < 0.05). Bouts ≥60 min were longer for men than women (p < 0.05). The duration of sedentary breaks was longer during weekdays than weekend days (p < 0.001). There were no differences between age-groups.

CONCLUSIONS

Adults with ID spend a large portion of the day in SB primarily of short bouts. Despite small differences, SB levels and patterns were similar for men and women with ID and across age-groups throughout the week.

Are legume-based recipes an appropriate source of nutrients for healthy ageing? A prospective cohort study

Although legumes are rich in protein and fibre, and low in saturated fat and Na, traditional legume-based recipes include substantial amounts of processed meat, salt and potatoes, which could counteract the potential benefits of legumes. This prospective study aimed to assess the longitudinal association of consumption of different types of legumes, and traditional legume-based recipes, with unhealthy ageing in older adults. Data were taken from 2505 individuals aged ≥60 years from the Seniors-ENRICA cohort. Habitual legume consumption was assessed in 2008-2010 with a validated diet history. Unhealthy ageing was measured in the 2013, 2015 and 2017 follow-up waves, with a fifty-two-item multidimensional health deficit accumulation index (DAI) which ranges from 0 (best) to 100 (worst health). The mean age was 68·7 years, with 53·1 % of women. Among study participants, 78·4 % reported consumption of legumes, with a mean intake of 57·9 g/d. Multivariable-adjusted linear regression models did not show an association between total legume consumption and the DAI over a 7-year follow-up (non-standardised coefficient for the second and highest v. the lowest tertile of consumption: 0·94 (95 % CI -0·30, 2·17) and 0·18 (95 % CI -1·07, 1·43), respectively; Ptrend = 0·35). Similar results were observed for the 3-year and 5-year follow-ups and, separately, for lentils, beans, chickpeas and traditional legume-based recipes. According to the results obtained, consumption of legumes and traditional legume-based recipes is not associated with unhealthy ageing and can be part of a healthy diet in old age.

Body Expression-Based Intervention Programs for Persons with Intellectual Disabilities: A Systematic Review

The benefits of physical exercise on human health are widely known. However, the level of physical activity in the majority of the population is considered insufficient. People with intellectual disabilities (ID), in particular, show this lack of physical activity to a greater extent. It has been noted that the promotion of activities focused on corporal expression (CE) stimulates the motivation to carry out physical exercise in this population group. The aim of this study was to carry out a systematic review of the last ten years of CE programs carried out in people with ID. The criteria established in the PRISMA statement were followed in the literature search. The databases consulted were Scopus, Web of Science, Pubmed, PsycInfo and Elton B. Stephens Company (EBSCO). Eight exclusion criteria were established for the selection of articles. For the analysis of the selected research, three quality criteria for interventions were established. Subsequently, a summary table with the characteristics of each study was made. In conclusion, it can be stated that CE programs in people with ID report benefits at both physical and psychosocial levels. It is necessary to extend this approach for the promotion of healthy physical activity that advocates social inclusion.

Predictors of perceived health in adults with an intellectual disability

BACKGROUND

The effects of Intellectual disability (ID) levels, body mass index (BMI) categories, and other factors on perceived health status of adults with ID are not well-known.

AIMS

We aimed to examine: (a) the relationship between perceived health and level of intellectual function; (b) the influence of different BMI categories on a perceived health; and (c) the effect of the modifiable behavioral factors on perceived health.

METHODS AND PROCEDURES

We examined the aims using data from the 2013-2014 Adult Consumer Survey of the National Core Indicator. We extracted demographic (e.g. age, BMI) and modifiable behavior-related variables (e.g. physical activity participation, having a job) and used logistic regression models to analyze the relationships.

OUTCOMES AND RESULTS

Logistic regressions showed that more severe ID level is associated with worse perceived health, but when other variables related to personal and behavioral characteristics were accounted for, this relationship was no longer significant. Obese adults with ID had worse perceived health than those with normal weight; this effect remained significant even after considering other variables. Those in the overweight category did not differ in perceived health status from those of normal weight. The effects of all modifiable behaviors on perceived health were significant.

CONCLUSIONS AND IMPLICATIONS

Health promotion programs for adults with ID may benefit by consideration of modifiable behaviors.

Leisure-time physical activity and all-cause mortality among adults with intellectual disability: the National Health Interview Survey

BACKGROUND

Adults with intellectual disabilities (IDs) have higher rates of morbidity and mortality compared with the general population, necessitating a need to identify modifiable targets for intervention to mitigate risk. While the benefits of leisure-time physical activity (PA) are well established in the general population; there is a dearth of evidence confirming its health benefits among adults with IDs. The purpose of this study was to examine the association between leisure-time PA and all-cause mortality among a population-based sample of adults with IDs.

METHODS

A total of 413 adults with IDs from 17 waves (1997-2014) of the National Health Interview Survey, a U.S. nationally representative survey, were studied. Minutes per week of leisure-time PA was ascertained by self-report and classified as poor, intermediate or ideal levels of PA.

RESULTS

Over a median follow-up of 7.2 years, 60 participants died. In a multivariable-adjusted model, higher levels of leisure-time PA were dose-dependently associated with a lower risk of all-cause mortality (P-trend = 0.008). The multivariable-adjusted hazard ratios (95% confidence interval) for all-cause mortality comparing participants with intermediate and ideal versus poor levels of PA were 0.43 (0.18, 1.04) and 0.30 (0.10, 0.87), respectively.

CONCLUSION

These findings show that leisure-time PA confers mortality benefit in adults with IDs and should be considered as a priority target for promoting health and longevity in this population.

Systematic review of sedentary behaviour in people with Down syndrome across the lifespan: A clarion call

BACKGROUND

Individuals with Down syndrome (DS) experience health disparities possibly associated with high levels of sedentary behaviour (SB). We systematically reviewed SB measurement, levels, patterns, correlates, consequences and interventions in people with DS across the lifespan.

METHOD

We searched these databases: Embase; PubMed; Web of Science; Scopus; CINAHL; PsycINFO; SPORTDiscus; and Cochrane Library. We included quantitative studies published in English since 1 January 1990.

RESULTS

We identified 17 eligible articles. Across studies, accelerometer-determined sedentary time was 552 min/day (median: 542; range 392-680 min/day). Sedentary time appeared higher than previously reported values in the general population, especially for youth with DS. Multivariate SB correlates were primarily familial and environmental. Sedentary behaviour consequences have not been exclusively studied. Motor skills training reduced SB in youth with DS.

CONCLUSIONS

Sedentary behaviour research in this population is in early stages. Individuals with DS have high levels of SB that may be responsive to interventions.

Gender differences in physical activity and sedentary behaviour in adults with intellectual disabilities: A systematic review and meta-analysis

BACKGROUND

Adults with intellectual disabilities are reported to be highly inactive, with research required to understand contributory factors. This systematic review aimed to investigate gender differences in physical activity (PA) and sedentary behaviour (SB) in adults with intellectual disabilities.

METHODS

This systematic review was reported in accordance with PRISMA guidelines. Seven databases were searched up to, and including, January 2018. Screening identified papers that assessed gender-specific PA and/or SB outcomes in adults with intellectual disabilities. Data were synthesized using a narrative synthesis and random effects model meta-analyses.

RESULTS

Twenty-six papers were included; 25 measured PA, and eight assessed SB. Women with intellectual disabilities were least active with a significant overall effect of gender identified. For SB, no consistent gender differences were found.

CONCLUSIONS

Reflecting the general population, men with intellectual disabilities were most active. Intellectual disability research should consider the role of gender to inform future interventions targeting inactivity.

Tai Chi as an Alternative Exercise to Improve Physical Fitness for Children and Adolescents with Intellectual Disability

Objective: The purpose of this study was to investigate the effects of Tai Chi (TC) on anthropometric parameters and physical fitness among children and adolescents with intellectual disabilities (ID). Methods: Sixty-six Chinese individuals engaged in sport-related extracurricular activities (TC and aerobic exercise (AE)) as exercise interventions or arts/crafts activities as a control condition (CON). The experimental protocol consisted of a baseline assessment, a 12-week intervention period, and a post-intervention assessment. Results: Significant interaction effect was only observed in the performance of a 6-min walk test. After 12 weeks of intervention, the AE group had significant changes in body mass index (p = 0.006, d = 0.11), sit-ups (p = 0.030 and d = 0.57), and 6-min walk test (p = 0.005, d = 0.89). Significant increases in vertical jump (p = 0.048, d = 0.41), lower-limb coordination (p = 0.008, d = 0.53), and upper-limb coordination (p = 0.048, d = 0.36) were observed in the TC group. Furthermore, the TC group demonstrated significantly greater improvements on balance compared to the control group (p = 0.011). Conclusions: TC may improve leg power and coordination of both lower and upper limbs, while AE may be beneficial for body mass index, sit-ups and cardiorespiratory fitness.

Correlates of Sedentary Behaviour in Adults with Intellectual Disabilities-A Systematic Review

Individuals with intellectual disabilities (ID) are at high risk for high levels of sedentary behaviour. To inform the development of programmes to reduce sedentary behaviour, insight into the correlates is needed. Therefore, the aim of this study is to review the evidence on correlates of sedentary behaviour in adults with ID. We performed a systematic literature search in Ovid Medline, Ovid Embase, Web of Science and Google Scholar up to 19 January 2018, resulting in nine included studies that were published from 2011 to 2018. Correlates were categorized according to the ecological model. Studies predominantly focused on individual level correlates. Of those correlates studied in more than one study, having epilepsy was associated with less sedentary behaviour and inconsistent results were found for sex, genetic syndromes, weight status, physical health, mobility, level of ID, and mental health. Of the few interpersonal and environmental factors studied, only living arrangements were studied in more than one study, with inconsistent results. To date, we have limited and inconclusive evidence about correlates of sedentary behaviour in adults with ID. Only when future studies unravel correlates and determinants, across all domains of the ecological model, will the potential opportunities to improve health by reducing sedentary behaviour come within reach.

Emerging Trends in Health Promotion for People with Disabilities

The need among people with disabilities to improve their own health and prevent/manage secondary conditions requires a better balance between reactive and anticipatory care.