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Westrop SC, Rana D, Jaiswal N, Wu O, McGarty AM, Melville C, Ells L, Lally P, McEwan M, Harris L, Germeni E. Supporting active engagement of adults with intellectual disabilities in lifestyle modification interventions: a realist evidence synthesis of what works, for whom, in what context and why. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:293-316. [PMID: 38379511 DOI: 10.1111/jir.13120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 11/10/2023] [Accepted: 12/19/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Lifestyle modification interventions for adults with intellectual disabilities have had, to date, mixed effectiveness. This study aimed to understand how lifestyle modification interventions for adults with intellectual disabilities work, for whom they work and in what circumstances. METHODS A realist evidence synthesis was conducted that incorporated input from adults with intellectual disabilities and expert researchers. Following the development of an initial programme theory based on key literature and input from people with lived experience and academics working in this field, five major databases (MEDLINE, EMBASE, CINAHL, PsycINFO and ASSIA) and clinical trial repositories were systematically searched. Data from 79 studies were synthesised to develop context, mechanism and outcome configurations (CMOCs). RESULTS The contexts and mechanisms identified related to the ability of adults with intellectual disabilities to actively take part in the intervention, which in turn contributes to what works, for whom and in what circumstances. The included CMOCs related to support involvement, negotiating the balance between autonomy and behaviour change, fostering social connectedness and fun, accessibility and suitability of intervention strategies and delivery and broader behavioural pathways to lifestyle change. It is also essential to work with people with lived experiences when developing and evaluating interventions. CONCLUSIONS Future lifestyle interventions research should be participatory in nature, and accessible data collection methods should also be explored as a way of including people with severe and profound intellectual disabilities in research. More emphasis should be given to the broader benefits of lifestyle change, such as opportunities for social interaction and connectedness.
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Affiliation(s)
- S C Westrop
- Mental Health and Wellbeing, School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - D Rana
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - N Jaiswal
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - O Wu
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - A M McGarty
- Mental Health and Wellbeing, School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - C Melville
- Mental Health and Wellbeing, School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - L Ells
- Obesity Institute, School of Health, Leeds Beckett University, City Campus, Leeds, UK
| | - P Lally
- UCL Institute of Epidemiology and Health Care, University College London, London, UK
- Department of Psychology, University of Surrey, Guildford, UK
| | - M McEwan
- People First (Scotland), Edinburgh, UK
| | - L Harris
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - E Germeni
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Özdemir A, Hall R, Lovell A, Ellahi B. Nutrition knowledge and influence on diet in the carer-client relationship in residential care settings for people with intellectual disabilities. NUTR BULL 2023; 48:74-90. [PMID: 36647738 DOI: 10.1111/nbu.12600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 01/18/2023]
Abstract
People with intellectual disabilities generally have poorer health outcomes compared with those who do not, including outcomes related to nutrition-related non-communicable diseases. Carers support people with intellectual disabilities in many aspects including habitual shopping and preparation of food, but their own nutrition knowledge and the influence this may have on dietary intakes of clients is unknown. We explored the nutrition knowledge of carers of people with intellectual disabilities in residential care settings, their dietary habits and their influence on clients' food shopping and preparation and therefore the diet consumed by their clients. Ninety-seven carers belonging to a large independent care sector organisation specialising in the care of people with an intellectual disability completed a validated general nutrition knowledge and behaviour questionnaire. Seventeen carers from the residential care settings were interviewed to contextualise practice. Knowledge about key dietary recommendations scored highly. Carers who had more work experience were found to have higher scores in 'making everyday food choices' (p = 0.034). Daily consumption of fruit and vegetables (at least one portion per day) was observed (for fruit by 46% of the carers and for vegetables by 60% of the carers), whilst most carers reported avoiding consuming full-fat dairy products, sugary foods and fried foods. The concept of a healthy diet; typical dietary habits of clients; role in food acquisition; and training in nutrition emerged as themes from the interviews. Carers discussed various topics including the importance of a balanced diet, cooking fresh foods and control of food portion sizes for clients relative to the care philosophy of a client-centred approach, which encapsulates client autonomy. Gaps in knowledge around specific nutrients, making healthy choices and cooking skills remain. Carers have an influence on clients' dietary choices; they are able to provide healthy meals and share good dietary habits with clients. Further training in nutrition is recommended for impact on clients' health.
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Affiliation(s)
- Aslıhan Özdemir
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Rebecca Hall
- Department of Mental Health and Learning Disabilities, Faculty of Health and Social Care, University of Chester, Chester, UK.,School of Nursing, Midwifery and Social Work, University of Salford, Salford, UK
| | - Andrew Lovell
- Department of Social Work and Interprofessional Studies, Faculty of Health and Social Care, University of Chester, Chester, UK
| | - Basma Ellahi
- Department of Social Work and Interprofessional Studies, Faculty of Health and Social Care, University of Chester, Chester, UK
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Anderson J, Wickham S. Perspectives on delivering health promotion for the intellectual disability population. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:640-646. [PMID: 35736856 DOI: 10.12968/bjon.2022.31.12.640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The qualitative study reported in this article set out to develop an understanding of how staff supporting individuals with intellectual disabilities deliver health promotion in their practice. The aim was to determine how social care managers working within an intellectual disability care setting in Ireland perceived health promotion and their role within it. Semi-structured interviews were conducted to collect the data. Participants perceived health promotion to be a priority for this population group that should be tailored to meet individual needs. Study participants recognised that they have a role in supporting and providing health promotion for this population, but also that they themselves required more training and education on the issue. Health promotion enablers identified in the study for this client group need to be enhanced and ways to reduce the barriers to access identified. The results reflect observations reported in the literature and indicate a need to prioritise health promotion with this population by establishing policies and practices in the organisation to promote it. A requirement for relevant training and education for social care managers-and other staff, as appropriate-was identified, as were areas for further research.
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Affiliation(s)
- Joanne Anderson
- Clinical Nurse Manager, Respite Services, St Michael's House, Dublin
| | - Sheelagh Wickham
- Assistant Professor, School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin
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Bains KK, Turnbull T. Conducting theory-based qualitative interviews with adults with intellectual disabilities and their carers: Adaptations to facilitate participation. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:556-568. [PMID: 34873792 DOI: 10.1111/jar.12966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/28/2021] [Accepted: 11/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adults with mild-moderate intellectual disabilities have difficulties in accessing traditional evidence-based health promotion initiatives despite experiencing health disparities; yet there are few studies with this group and their carers exploring how their needs can be met. METHOD This study adapted a behaviour change theory-based approach to interview this group and their carers and ascertain if this method was feasible and appropriate to explore how healthier behaviour uptake could be improved amongst adults with intellectual disabilities. RESULTS A community-based, staged recruitment process and iterative approach to data collection and analysis supported successful participation amongst adults with intellectual disabilities in behaviour-change theory-based interview research. Methodological adaptations enabled richer data collection amongst adults with mild-moderate intellectual disabilities and carers. CONCLUSIONS It is feasible and important to include adults with intellectual disabilities in qualitative health research that uses theory-based complex constructs to inform development of person-centred health promotion interventions with this underserved cohort.
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Affiliation(s)
- Kiran K Bains
- School of Health Sciences, City University of London, London, UK
| | - Triece Turnbull
- Department of Health, Psychology and Communities, Manchester Metropolitan University, Manchester, UK
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Lally P, Beeken RJ, Wilson R, Omar R, Hunter R, Fovargue S, Anderson D, King M, Hassiotis A, Croker H. A manualised weight management programme for adults with mild-moderate intellectual disabilities affected by excess weight: A randomised controlled feasibility trial (Shape Up-LD). JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:112-122. [PMID: 34297441 DOI: 10.1111/jar.12922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 05/11/2021] [Accepted: 05/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim was to pilot an adapted manualised weight management programme for persons with mild-moderate intellectual disabilities affected by overweight or obesity ('Shape Up-LD'). METHOD Adults with intellectual disabilities were enrolled in a 6-month trial (3-month active intervention and 3-month follow-up) and were individually randomised to Shape Up-LD or a usual care control. Feasibility outcomes included recruitment, retention, initial effectiveness and cost. RESULTS Fifty people were enrolled. Follow-up rates were 78% at 3 months and 74% at 6 months. At 3 and 6 months, controlling for baseline weight, no difference was observed between groups (3 months: β: -0.34, 95% confidence interval [CI]: -2.38, 1.69, 6 months: β: -0.55, 95%CI -4.34, 3.24). CONCLUSION It may be possible to carry out a trial of Shape Up-LD, although barriers to recruitment, carer engagement and questionnaire completion need to be addressed, alongside refinements to the intervention.
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Affiliation(s)
- Phillippa Lally
- Department of Behavioural Science and Health, University College London, London, UK
| | - Rebecca J Beeken
- Department of Behavioural Science and Health, University College London, London, UK.,Leeds Institute of Health Sciences, London, UK
| | - Rose Wilson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Rumana Omar
- Department of Statistical Science, University College London, London, UK
| | - Rachael Hunter
- Department of Primary Care & Population Health, University College London, London, UK.,Priment Clinical Trials Unit, London, UK
| | | | | | - Michael King
- Division of Psychiatry, University College London, London, UK
| | | | - Helen Croker
- Department of Behavioural Science and Health, University College London, London, UK
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Hung OHY, Ma JCY. The utility of 'Ding Ding Lok' in rehabilitation service for adult persons with intellectual disability: A thematic analysis on reports by service staff. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2021; 25:50-64. [PMID: 31272260 DOI: 10.1177/1744629519858554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This article introduces 'Ding Ding Lok' (DDL), a group game especially designed for persons affected by mild-to-moderate intellectual disability and explores its utility in rehabilitation service settings in Hong Kong. Reports from service staff who participated in the pilot project were analysed using thematic analysis. Two key questions were explored: (1) staff members' perceived benefits of the game for service users and (2) source of enjoyment for staff members in the game process. Results of the thematic analysis generated four themes, including 'Social Repertoire Expansion', 'Exercising Cognitive Abilities', 'Leisure & Recreation' and 'Personal growth' for the first question on perceived benefits and five themes including 'Positive interactions', 'Users' positive feelings', 'Increased understanding', 'Game design' and 'Users' improvement' for the second question on source of enjoyment for staff members. On the whole, DDL was perceived to be highly beneficial for the service users and were regarded as very enjoyable to the participating service staff.
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Ptomey LT, Szabo-Reed AN, Martin LE, Mayo MS, Washburn RA, Gorczyca AM, Lepping RJ, Lee P, Forsha DE, Sherman JR, Danon JC, Donnelly JE. The promotion of physical activity for the prevention of Alzheimer's disease in adults with Down Syndrome: Rationale and design for a 12 Month randomized trial. Contemp Clin Trials Commun 2020; 19:100607. [PMID: 32642594 PMCID: PMC7334572 DOI: 10.1016/j.conctc.2020.100607] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/16/2020] [Accepted: 06/28/2020] [Indexed: 11/23/2022] Open
Abstract
Nearly all individuals with Down Syndrome (DS) display pathology associated with Alzheimer's disease (AD) beginning as early as age 30. Previous research in typically developed adults suggests that increased moderate-to-vigorous physical activity (MVPA) may improve cognitive function and protect against age-related structural and functional changes in the brain; however, the potential impact of increased MVPA on the development of AD in adults with DS has not been evaluated. Despite the potential positive impact of MVPA on cognition and AD risk, participation in MVPA among young adults with DS is low. The limited research evaluating strategies for increasing MVPA in adults with DS has been unsuccessful in increasing MVPA. Results from our preliminary investigation where we remotely delivered real-time MVPA, led by a trained health educator, to groups of adults with DS in their homes via video conferencing on a tablet computer demonstrated high attendance, increased MVPA during group sessions, and improvements in cognitive function. However, the sustainability, impact on total daily MVPA, optimal session frequency, and potential impacts on cognitive function and brain health of remotely delivered group MVPA sessions in adults with DS are unknown. Therefore, we will conduct a trial in 80 non-demented adults with DS to determine the feasibility and potential efficacy of remotely delivered group MVPA sessions to increase daily MVPA, relative to a usual care control. Secondarily we will assess the impact of MVPA on cardiovascular fitness, quality of life, cognitive function and brain parameters related to AD. NCT REGISTRATION NCT04048759.
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Affiliation(s)
- Lauren T. Ptomey
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Amanda N. Szabo-Reed
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Laura E. Martin
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, USA
| | - Matthew S. Mayo
- Department of Biostatistics & Data Science, University of Kansas Medical Center, USA
| | - Richard A. Washburn
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Anna M. Gorczyca
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Rebecca J. Lepping
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, USA
| | - Phill Lee
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Daniel E. Forsha
- Ward Family Heart Center, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Joseph R. Sherman
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Jessica C. Danon
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Joseph E. Donnelly
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
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Doherty AJ, Jones SP, Chauhan U, Gibson J. Eating well, living well and weight management: A co-produced semi-qualitative study of barriers and facilitators experienced by adults with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2020; 24:158-176. [PMID: 29764278 DOI: 10.1177/1744629518773938] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Adults with intellectual disabilities in England experience health inequalities. They are more likely than their non-disabled peers to be obese and at risk of serious medical conditions such as heart disease, stroke and type 2 diabetes. This semi-qualitative study engaged adults with intellectual disabilities in a co-production process to explore their perceived barriers and facilitators to eating well, living well and weight management. Nineteen participants with intellectual disabilities took part in four focus groups and one wider group discussion. They were supported by eight of their carers or support workers. Several barriers were identified including personal income restrictions, carers' and support workers' unmet training needs, a lack of accessible information, inaccessible services and societal barriers such as the widespread advertising of less healthy foodstuffs. A key theme of frustration with barriers emerged from analysis of participants' responses. Practical solutions suggested by participants included provision of clear and accessible healthy lifestyle information, reasonable adjustments to services, training, 'buddying' support systems or schemes and collaborative working to improve policy and practice.
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Affiliation(s)
- A J Doherty
- School of Nursing, Faculty of Health & Wellbeing, University of Central Lancashire, UK
| | - S P Jones
- School of Nursing, Faculty of Health & Wellbeing, University of Central Lancashire, UK
| | - U Chauhan
- MacKenzie Chair in Primary Care Medicine, Faculty of Clinical and Biomedical Sciences, University of Central Lancashire
| | - Jme Gibson
- School of Nursing, Faculty of Health & Wellbeing, University of Central Lancashire, UK
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Bellamy J, Broderick C, Hardy LL, Simar D, Puusepp-Benazzouz H, Ong N, Silove N. Feasibility of a school-based exercise intervention for children with intellectual disability to reduce cardio-metabolic risk. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:7-17. [PMID: 31625658 DOI: 10.1111/jir.12690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 08/28/2019] [Accepted: 08/30/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND People with intellectual disabilities (ID) are at increased risk of secondary health conditions, reduced quality of life and life expectancy. Children with ID demonstrate low levels of physical activity in association with a higher prevalence of obesity, a modifiable risk factor associated with secondary health conditions including type 2 diabetes and cardiovascular disease. Despite this, physical activity interventions addressing weight and weight-related complications in this population are limited. This study aimed to establish the feasibility of a school-based group exercise intervention for children with moderate to severe ID. METHODS A single-arm intervention study was used to establish the feasibility of a 16-week exercise intervention. Children attending a School for Specific Purposes in Sydney, Australia, participated in two 30-min exercise sessions per week across the intervention period in addition to their regular physical education class. Each exercise session was 60% aerobically based, 20% strength based and 20% targeted towards fundamental movement skill development. We used two facilitation strategies to assist the delivery of the intervention, including the implementation of a variety of communication resources and promotion of social interaction. Feasibility was assessed through recruitment rates, program retention, adverse effects, attendance, group size feasibility and non-compliance. Anthropometric measures included height (m), weight (kg) and waist circumference (cm; umbilicus), with body mass index (BMI) and waist-to-height ratios (WtHR) used to determine cardio-metabolic risk. Aerobic capacity was assessed using the submaximal 6-min walk test (6-MWT). Intensity of physical activity sessions was measured through the use of tri-axial accelerometers and compared to physical activity recommendations. RESULTS Ten children aged between 9 and 13 years completed the 16-week intervention, with a 55% recruitment rate, 91% program retention, 86% attendance and with no adverse effects reported. Sessions commenced as 1:1 supervisor to child ratios before progressing to established small groups of 2:7 (supervisor : child). Children spent 38.4% (11.5 min) of each session in moderate to vigorous physical activity (MVPA), equating to 20% of their MVPA recommended daily physical activity levels (twice per week). There was a significant change in weight across the intervention period, with a trend towards increased weight between mid-intervention and 3-month follow-up time points. There were no significant changes in child BMI, WtHR or aerobic capacity. CONCLUSIONS A school-based group exercise intervention for children with moderate to severe ID is feasible and safe, with high retention rates and physical activity participation. No significant improvements in body composition or aerobic capacity were determined. The present study demonstrates that engaging children with moderate-severe ID in school-based group exercise is feasible to assist in physical activity participation.
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Affiliation(s)
- J Bellamy
- Faculty of Medicine, School of Medical Sciences, Department of Exercise Physiology, UNSW Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, New South Wales, Australia
| | - C Broderick
- Faculty of Medicine, School of Medical Sciences, Department of Exercise Physiology, UNSW Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, New South Wales, Australia
| | - L L Hardy
- Prevention Research Collaboration, The University of Sydney, New South Wales, Australia
| | - D Simar
- Faculty of Medicine, School of Medical Sciences, Department of Exercise Physiology, UNSW Sydney, New South Wales, Australia
| | | | - N Ong
- The Children's Hospital at Westmead, New South Wales, Australia
| | - N Silove
- The Children's Hospital at Westmead, New South Wales, Australia
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Doherty AJ, Jones SP, Chauhan U, Gibson JME. Healthcare practitioners' views and experiences of barriers and facilitators to weight management interventions for adults with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:1067-1077. [PMID: 30983088 DOI: 10.1111/jar.12596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 03/19/2019] [Accepted: 03/21/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Obesity is common in adults with intellectual disabilities, yet little is known about how weight management interventions are provided for this population. METHODS Semi-structured interviews were held with 14 healthcare practitioners involved in weight management interventions in an English county. A study topic guide was developed to elicit practitioners' views and experiences of barriers and facilitators to weight management for adults with intellectual disabilities. Responses were analysed using thematic analysis. RESULTS Several barriers are involved in weight management for people with intellectual disabilities including communication challenges, general practitioners' lack of knowledge and awareness of weight management services, inconsistencies in caring support, resource constraints, wider external circumstances surrounding the individuals and motivational issues. Facilitators include reasonable adjustments to existing weight management services. However, there is a need for specialist weight management provision for people with intellectual disabilities. CONCLUSIONS This study provides suggestions for future research, policy and practice consideration.
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Harris L, Hankey C, Jones N, Murray H, Pert C, Tobin J, Boyle S, Shearer R, Melville CA. Process evaluation of a cluster-randomised controlled trial of multi-component weight management programme in adults with intellectual disabilities and obesity. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:49-63. [PMID: 30417575 DOI: 10.1111/jir.12563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/10/2018] [Accepted: 09/27/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Providing effective weight management to adults with intellectual disabilities is necessary to challenge the high rates of obesity. The aim of this process evaluation was to explore the feasibility of conducting a full-scale clinical trial of the TAKE 5 multi-component weight management programme. METHODS The study was a 12-month pilot cluster-randomised controlled trial. Adults with intellectual disabilities and obesity were randomised to either TAKE 5, which included an energy deficit diet (EDD) or Waist Winners Too, based on health education principles. A mixed-methods process evaluation was conducted focussing on the reach, recruitment, fidelity, implementation, dose (delivered/received) and context. RESULTS The study successfully recruited adults with intellectual disabilities. Both weight management programmes were delivered with high fidelity and implemented as intended. Only one weight management programme, TAKE 5, demonstrated potential efficacy in reducing body weight and body composition. The effectiveness was largely attributed to the EDD and social support from carers. CONCLUSIONS The extensive process evaluation illustrated that a full-scale trial of a multi-component programme including an EDD is feasible and an acceptable approach to weight management for adults with intellectual disabilities and obesity.
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Affiliation(s)
- L Harris
- College of Medical Veterinary and Life Sciences, Institute of Mental Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - C Hankey
- College of Medical Veterinary and Life Sciences, Institute of Mental Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - N Jones
- College of Medical Veterinary and Life Sciences, Institute of Mental Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - H Murray
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - C Pert
- Learning Disability Psychology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - J Tobin
- Glasgow City CHP North East Sector, Eastbank Conference Training Centre, Glasgow, UK
| | - S Boyle
- Consultant Clinical Psychologist NHS Greater, Glasgow, UK
| | - R Shearer
- Glasgow and Clyde Specialist Weight Management Service, Glasgow, UK
| | - C A Melville
- College of Medical Veterinary and Life Sciences, Institute of Mental Health and Wellbeing, University of Glasgow, Glasgow, UK
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Croot L, Rimmer M, Salway S, Hatton C, Dowse E, Lavin J, Bennett SE, Harris J, O'Cathain A. Adjusting a mainstream weight management intervention for people with intellectual disabilities: a user centred approach. Int J Equity Health 2018; 17:159. [PMID: 30348176 PMCID: PMC6198382 DOI: 10.1186/s12939-018-0871-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/08/2018] [Indexed: 11/10/2022] Open
Abstract
Background People with intellectual disabilities (ID) may not be able to access and respond to uniformly delivered health interventions. Public bodies have a legal duty to make ‘reasonable adjustments’ to policies and practices to provide fair access and treatment for people with ID. This study aimed to identify adjustments to the Slimming World weight management programme to improve accessibility and assess acceptability and feasibility for this population. Methods This user-centred qualitative study was carried out with a steering group of people with ID (n = 4). Barriers and facilitators to using Slimming World were identified through interviews and focus groups with people with ID (n = 54), carers (n = 12) current members with ID (n = 8) and Slimming World group leaders (n = 11). Adjustments were made and their feasibility and acceptability were explored in a before-and-after mixed methods study where people with ID attended Slimming World for eight weeks. Participants (n = 9), carers (n = 7) and Slimming World group leaders (n = 4) were interviewed to explore their experiences of the adjustments. Participants were weighed at baseline then each week. Results Four key adjustments were identified and addressed by Slimming World who developed prototype Easy Read materials and a letter for carers. Six of the nine participants attended Slimming World for eight weeks and lost weight (1.4 kg to 6.6 kg, reduction in BMI between 0.5 and 1.7 kg/m2), indicating that the adjustments were feasible and acceptable. Two participants dropped out because they felt uncomfortable in a mainstream group and another left because they lacked control over food choice in their residential setting. Conclusions This user-centred approach identified reasonable adjustments that were feasible to implement. In a small uncontrolled feasibility study, people with ID were positive about the adjustments and lost weight. However, issues in the wider context of people’s lives, such as obesogenic environments and concerns about joining mainstream groups, limited the acceptability of Slimming World even with these adjustments. These findings have important implications for policy and suggest that environmental and organisational level interventions are needed alongside those targeting individual behaviour to tackle the obesogenic environment in which many people with ID spend their time, in order to reduce inequalities associated with the consequences of obesity.
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Affiliation(s)
- Liz Croot
- School of Health and Related Research, Sheffield University, Sheffield, UK.
| | - Melanie Rimmer
- School of Health and Related Research, Sheffield University, Sheffield, UK
| | - Sarah Salway
- School of Health and Related Research, Sheffield University, Sheffield, UK
| | - Chris Hatton
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Emma Dowse
- Slimming World Health and Research Team, Slimming World, Alfreton, UK
| | - Jacquie Lavin
- Slimming World Health and Research Team, Slimming World, Alfreton, UK
| | - Sarah E Bennett
- Slimming World Health and Research Team, Slimming World, Alfreton, UK
| | - Janet Harris
- School of Health and Related Research, Sheffield University, Sheffield, UK
| | - Alicia O'Cathain
- School of Health and Related Research, Sheffield University, Sheffield, UK
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Ptomey LT, Washburn RA, Mayo MS, Greene JL, Lee RH, Szabo-Reed AN, Honas JJ, Sherman JR, Donnelly JE. Remote delivery of weight management for adults with intellectual and developmental disabilities: Rationale and design for a 24 month randomized trial. Contemp Clin Trials 2018; 73:16-26. [PMID: 30145269 PMCID: PMC6176482 DOI: 10.1016/j.cct.2018.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/22/2018] [Accepted: 08/23/2018] [Indexed: 01/28/2023]
Abstract
Adults with intellectual and developmental disabilities (IDD) represent an underserved segment of the US population with a high prevalence of obesity and limited options for weight management. Previous research has demonstrated clinically meaningful weight loss of 7% of total body weight in in adults with IDD using an enhanced Stop Light Diet (eSLD) in combination with monthly at-home face-to-face (FTF) behavioral sessions, and a recommendation for increased physical activity. However, the time and cost associated with FTF delivery (travel + sessions) limits the potential for scaling and implementation and suggests the need for the evaluation of less costly and burdensome strategies for intervention delivery. Therefore, we will conduct a 24-mo. randomized trial to compare a weight management intervention (6 mos. weight loss, 12 mos. maintenance, 6 mos. no-contact follow-up) delivered to 120 overweight/obese adults with IDD in their home, either remotely (RD) using video conferencing on a tablet computer, or during FTF visits. Our primary aim is whether RD is non-inferior to FTF for weight loss (0-6 mos.). Secondarily, we will compare the RD and FTF groups on mean weight loss, the proportion of participants who achieve clinically meaningful weight loss, and changes in quality of life across 24 months. We will also conduct cost analysis, cost-effectiveness, and contingent valuation analyses to compare the RD and FTF groups.
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Affiliation(s)
- Lauren T Ptomey
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Richard A Washburn
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Matthew S Mayo
- Department of Biostatistics, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - J Leon Greene
- Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, KS 66045, USA.
| | - Robert H Lee
- Department of Health Policy and Management, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Amanda N Szabo-Reed
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Jeffery J Honas
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Joseph R Sherman
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Joseph E Donnelly
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
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Mitchell F, Stevens G, Jahoda A, Matthews L, Hankey C, Murray H, Melville C. The lifestyle behaviours of young adults with intellectual disabilities as they transition from school to adulthood: A pilot and feasibility study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 31:1154-1163. [PMID: 29953690 DOI: 10.1111/jar.12489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/09/2018] [Accepted: 05/23/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the general population, the transition from adolescence to adulthood has been identified as a "high-risk" period for weight gain. There has been no research examining health behaviours over this transition in adults with intellectual disabilities. METHODS/DESIGN The feasibility of recruitment, retention and relevant health behaviours were measured in 31 adolescents with mild-moderate intellectual disabilities. Anthropometric, objective physical activity, dietary and self-determination measures were collected over a 12-month transitional period from school to adulthood. RESULTS Key results suggest weight and BMI increased significantly from month 6 to month 12 (p = 0.044 and p = 0.043). Waist circumference increased significantly from baseline to month 12 (p = 0.049), and from month 6 to month 12 (p = 0.03). DISCUSSION Recruiting and retaining young adults with intellectual disabilities over a 12-month health behaviour study is feasible. The data indicate the transition from school to adulthood may be the start of a high-risk period for weight gain.
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Affiliation(s)
- Fiona Mitchell
- Physical Activity and Health Research Group, University of Strathclyde, Glasgow, UK
| | - Gemma Stevens
- School of Applied Social Studies, Robert Gordon University, Aberdeen, UK
| | - Andrew Jahoda
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lynsay Matthews
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Heather Murray
- Institute of Health and Wellbeing, Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Craig Melville
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Pan CC, Davis R. Exploring physical self-concept perceptions in athletes with intellectual disabilities: the participation of Unified Sports experiences. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2018; 65:293-301. [PMID: 34141350 PMCID: PMC8115608 DOI: 10.1080/20473869.2018.1470787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVES Self-description research on athletes with intellectual disabilities (ID) is under investigated. The specific aims in this paper are (a) to identify the differences in physical self-concept and body image by Unified Sports experiences, and (b) to investigate predictors of physical self-concept. METHODS Participants included 89 Special Olympics athletes who had Unified Sports experiences (USE, n = 43) and those without USE (n = 46). Demographic, anthropometric, self-description data were collected during the questionnaire interview and physical examination. Analyses included descriptive and regression modeling to determine differences in the psychological attributes by USE and best subsets of predictors of each physical self-concept construct. RESULTS The findings suggest that the participation of USE facilitated greater sport competence and there is no single predictor across the six physical self-concept constructs. CONCLUSION The findings provide evidence that sports participation may have positive impacts on physical self-concept toward athletes with ID.
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Affiliation(s)
- Cheng-Chen Pan
- Special Education Center, National Taiwan Normal University, Taipei, Taiwan
- Correspondence to: Cheng-Chen Pan, Special Education Center, National Taiwan Normal University, Taipei, Taiwan.
| | - Ronald Davis
- Kinesiology, Texas Woman’s University, Denton, TX, USA
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Ptomey LT, Szabo AN, Willis EA, Greene JL, Danon JC, Washburn RA, Forsha DE, Donnelly JE. Remote Exercise for Adults with Down Syndrome. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2018; 3:60-65. [PMID: 29930988 PMCID: PMC6005664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE Adults with Down syndrome are less physically active than their typically developed peers. The purpose of this study was to assess the feasibility of delivering moderate-to- vigorous exercise sessions, led by a trained health educator using real-time video conferencing, to groups of young adults with Down syndrome in their homes. METHODS Participants were randomized to 30-minute group exercise sessions either 1 or 2 times a week delivered on an iPad mini tablet computer using the Zoom video conferencing application, and were asked to attend individual support/education sessions once a week using FaceTime® on the iPad, for 12 weeks. Minutes of MVPA during all group sessions were assessed using a Fitbit Charge HR activity/heart rate monitor. Participants were also asked to complete weekly homework assignments involving MVPA. RESULTS Twenty-seven participants (n = 14,1 session·wk-1, n =13, 2 sessions·wk-1), mean age 27.9 ± 7.1 yrs., ~ 41% female, enrolled in and completed the 12-wk. intervention. Attendance at group exercise and individual support/education sessions did not differ significantly between those randomized to 1 (exercise sessions =89.9 ± 8.8%, support/education sessions = 81.2 ±18.7%) or 2 sessions·wk-1 (exercise sessions = 88.8 ± 7.7%; p=0.79, support/education sessions= 86.0 ± 20.9%; p=0.87). Participants averaged 27.7 ± 5.7 mins·session-1 of MVPA with no significant difference between the 1 (26.6 ± 3.0 mins·session-1) and 2 session·wk-1 groups (28.8 ± 7.7 mins·session-1, p=0.16). The completion rate for homework assignments did not differ significantly between the 1 (21.4 ± 26.3%) and 2 session·wk-1 groups (37.7 ± 21.7%, p=0.28). CONCLUSION Exercise delivered by group video conferencing may be a feasible and potentially effective approach for increasing MVPA in adults with Down syndrome.
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Affiliation(s)
- Lauren T. Ptomey
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS
| | - Amanda N. Szabo
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS
| | - Erik A. Willis
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - J. Leon Greene
- Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, KS
| | - Jessica C. Danon
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS
| | - Richard A. Washburn
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS
| | - Daniel E. Forsha
- Ward Family Heart Center, Children’s Mercy Hospital, Kansas City, MO
| | - Joseph E. Donnelly
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS
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Doherty AJ, Jones SP, Chauhan U, Gibson JME. An integrative review of multicomponent weight management interventions for adults with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 31 Suppl 1:39-51. [PMID: 28631874 PMCID: PMC5811836 DOI: 10.1111/jar.12367] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Obesity is more prevalent in people with intellectual disabilities and increases the risk of developing serious medical conditions. UK guidance recommends multicomponent weight management interventions (MCIs), tailored for different population groups. METHODS An integrative review utilizing systematic review methodology was conducted to identify the types of MCIs delivered to adults with intellectual disabilities. FINDINGS Five studies were identified. All of the studies' MCIs were tailored for adults with intellectual disabilities. Tailoring included measures such as simplified communication tools, individualized sessions, and the presence of carers where appropriate. CONCLUSIONS Emerging evidence suggests ways in which MCIs can be tailored for adults with intellectual disabilities but, given the few studies identified, it is not possible to recommend how they can be routinely tailored. Further studies are justified for adults with intellectual disabilities at risk of obesity-related conditions.
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Affiliation(s)
- Alison J. Doherty
- National Institute for Health Research (NIHR)Collaboration for Leadership in Applied Health Research and Care, North West Coast (CLAHRC, NWC)PrestonUK
- School of NursingFaculty of Health & WellbeingUniversity of Central LancashirePrestonUK
| | - Stephanie P. Jones
- School of NursingFaculty of Health & WellbeingUniversity of Central LancashirePrestonUK
| | - Umesh Chauhan
- School of NursingFaculty of Health & WellbeingUniversity of Central LancashirePrestonUK
- MacKenzie Chair in Primary Care MedicineUniversity of Central Lancashire; GP and CVD LeadEast Lancashire Clinical Commissioning GroupUK
| | - Josephine M. E. Gibson
- National Institute for Health Research (NIHR)Collaboration for Leadership in Applied Health Research and Care, North West Coast (CLAHRC, NWC)PrestonUK
- School of NursingFaculty of Health & WellbeingUniversity of Central LancashirePrestonUK
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18
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A cluster randomised control trial of a multi-component weight management programme for adults with intellectual disabilities and obesity. Br J Nutr 2017; 118:229-240. [DOI: 10.1017/s0007114517001933] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AbstractThere have been few published controlled studies of multi-component weight management programmes that include an energy deficit diet (EDD), for adults with intellectual disabilities and obesity. The objective of this study was to conduct a single-blind, cluster randomised controlled trial comparing a multi-component weight management programme to a health education programme. Participants were randomised to either TAKE 5, which included an EDD or Waist Winners Too (WWToo), based on health education principles. Outcomes measured at baseline, 6 months (after a weight loss phase) and 12 months (after a 6-month weight maintenance phase), by a researcher blinded to treatment allocation, included: weight; BMI; waist circumference; physical activity; sedentary behaviour and health-related quality of life. The recruitment strategy was effective with fifty participants successfully recruited. Both programmes were acceptable to adults with intellectual disabilities, evidenced by high retention rates (90 %). Exploratory efficacy analysis revealed that at 12 months there was a trend for more participants in TAKE 5 (50·0 %) to achieve a clinically important weight loss of 5–10 %, in comparison to WWToo (20·8 %) (OR 3·76; 95 % CI 0·92, 15·30; 0·064). This study found that a multi-component weight management programme that included an EDD, is feasible and an acceptable approach to weight loss when tailored to meet the needs of adults with intellectual disabilities and obesity.
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O'Leary L, Taggart L, Cousins W. Healthy lifestyle behaviours for people with intellectual disabilities: An exploration of organizational barriers and enablers. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 31 Suppl 1:122-135. [DOI: 10.1111/jar.12396] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Lisa O'Leary
- Scottish Learning Disabilities Observatory, Academic Unit for Mental Health & Wellbeing; Gartnavel Royal Hospital, University of Glasgow; Glasgow UK
| | - Laurence Taggart
- Institute of Nursing and Health Research; School of Nursing, Ulster University, Jordanstown Campus; Newtownabbey Northern Ireland UK
| | - Wendy Cousins
- Institute of Nursing and Health Research; School of Nursing, Ulster University, Jordanstown Campus; Newtownabbey Northern Ireland UK
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Ptomey LT, Saunders RR, Saunders M, Washburn RA, Mayo MS, Sullivan DK, Gibson CA, Goetz JR, Honas JJ, Willis EA, Danon JC, Krebill R, Donnelly JE. Weight management in adults with intellectual and developmental disabilities: A randomized controlled trial of two dietary approaches. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 31 Suppl 1:82-96. [DOI: 10.1111/jar.12348] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Lauren T Ptomey
- Cardiovascular Research Institute; Department of Internal Medicine; The University of Kansas Medical Center; Kansas City KS USA
| | - Richard R Saunders
- The Schiefelbusch Institute for Lifespan Studies; The University of Kansas-Lawrence; Lawrence KS USA
| | - Muriel Saunders
- The Schiefelbusch Institute for Lifespan Studies; The University of Kansas-Lawrence; Lawrence KS USA
| | - Richard A Washburn
- Cardiovascular Research Institute; Department of Internal Medicine; The University of Kansas Medical Center; Kansas City KS USA
| | - Matthew S Mayo
- Department of Biostatistics; The University of Kansas Medical Center; Kansas City KS USA
| | - Debra K Sullivan
- Department of Dietetics and Nutrition; The University of Kansas Medical Center; Kansas City KS USA
| | - Cheryl A Gibson
- Department of Internal Medicine; The University of Kansas Medical Center; Kansas City KS USA
| | - Jeannine R Goetz
- Department of Dietetics and Nutrition; The University of Kansas Medical Center; Kansas City KS USA
| | - Jeff J Honas
- Cardiovascular Research Institute; Department of Internal Medicine; The University of Kansas Medical Center; Kansas City KS USA
| | - Erik A Willis
- Cardiovascular Research Institute; Department of Internal Medicine; The University of Kansas Medical Center; Kansas City KS USA
| | - Jessica C Danon
- Cardiovascular Research Institute; Department of Internal Medicine; The University of Kansas Medical Center; Kansas City KS USA
| | - Ron Krebill
- Department of Biostatistics; The University of Kansas Medical Center; Kansas City KS USA
| | - Joseph E Donnelly
- Cardiovascular Research Institute; Department of Internal Medicine; The University of Kansas Medical Center; Kansas City KS USA
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21
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Ptomey LT, Gibson CA, Lee J, Sullivan DK, Washburn RA, Gorczyca AM, Donnelly JE. Caregivers' effect on weight management in adults with intellectual and developmental disabilities. Disabil Health J 2017; 10:542-547. [PMID: 28215627 DOI: 10.1016/j.dhjo.2017.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/03/2017] [Accepted: 02/08/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Caregivers of adults with IDD often play a large role in the ability of adults with IDD to lose weight. OBJECTIVE The purpose of this study was to determine to examine the effects of the caregivers' perceived burdens and self-efficacy and their relationship to an individual (family member or paid staff) on weight changes across a weight management intervention for adults with IDD. METHODS Overweight/obese adults with mild to moderate IDD, along with assigned caregivers who served as their study partner, were randomized to an 18-month weight management intervention. The living environment and caregiver relationship were assessed at baseline. Caregivers completed questionnaires regarding perceived hassles, uplifts, and self-efficacy in helping the participant follow a weight management intervention. RESULTS 147 adults with IDD (∼57% women and ∼16% minorities) were included in data analysis. After 18 months, there were no differences in weight loss between participants who had a family member as their study partner and those who had a paid assistant as their study partner (-5.5 ± 5.2% vs. -5.6± 5.3% p = 0.16). However, paid assistants reported more hassles with following the diet intervention at 6 months (p < 0.05). Participants who had a paid assistant as their study partner were more likely to have multiple study partners during the study, which was correlated with smaller weight loss. CONCLUSION While caregivers are important for weight management of adults with IDD, the caregiver's relationship to the participant does not affect weight change in an intervention.
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Affiliation(s)
- L T Ptomey
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - C A Gibson
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - J Lee
- Institute for Measurement, Methodology, Analysis and Policy, Texas Tech University, 2500 Broadway, Lubbock, TX 79409, USA.
| | - D K Sullivan
- Department of Dietetics and Nutrition, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - R A Washburn
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - A M Gorczyca
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - J E Donnelly
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
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Mitchell F, Stalker K, Matthews L, Mutrie N, Melling C, McConnachie A, Murray H, Melville CA. A qualitative exploration of participants’ experiences of taking part in a walking programme: Perceived benefits, barriers, choices and use of intervention resources. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 31 Suppl 1:110-121. [DOI: 10.1111/jar.12326] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Fiona Mitchell
- Physical Activity and Health Research Group; University of Strathclyde; Glasgow UK
| | - Kirsten Stalker
- Glasgow School of Social Work; University of Strathclyde; Glasgow UK
| | - Lynsay Matthews
- MRC/CSO Social and Public Health Sciences Unit; Institute of Health and Wellbeing; University of Glasgow; Glasgow UK
| | - Nanette Mutrie
- Institute for Sport, Physical Education and Health Sciences; Moray House School of Education; University of Edinburgh; Edinburgh UK
| | - Chris Melling
- Head of Learning Disability Services; West CHCP Glasgow; Glasgow UK
| | - Alex McConnachie
- Institute of Health and Wellbeing; Robertson Centre for Biostatistics; University of Glasgow; Glasgow UK
| | - Heather Murray
- Institute of Health and Wellbeing; Robertson Centre for Biostatistics; University of Glasgow; Glasgow UK
| | - Craig A. Melville
- Institute of Health and Wellbeing; Robertson Centre for Biostatistics; University of Glasgow; Glasgow UK
- Institute of Health and Wellbeing; Mental Health and Wellbeing; University of Glasgow; Glasgow UK
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Matthews L, Mitchell F, Stalker K, McConnachie A, Murray H, Melling C, Mutrie N, Melville C. Process evaluation of the Walk Well study: a cluster-randomised controlled trial of a community based walking programme for adults with intellectual disabilities. BMC Public Health 2016; 16:527. [PMID: 27387203 PMCID: PMC4936049 DOI: 10.1186/s12889-016-3179-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 06/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Walking interventions can be effective in encouraging sedentary populations to become more active; however, limited research has explored the effectiveness of walking interventions for adults with intellectual disabilities. This process evaluation explored the delivery of a community based walking intervention for adults with intellectual disabilities. METHODS Walk Well was a single-blind cluster randomised controlled trial of a 12-week physical activity consultation-led walking intervention. 102 participants were randomised to the Walk Well intervention or a waiting list control group. Participants in the intervention group received three physical activity consultations with a walking advisor at baseline, 6 & 12-weeks. They were encouraged to use a pedometer to set goals and monitor their daily step count. Primary outcome was change in daily step count at 12-weeks. Process evaluation measures included qualitative interviews with key stakeholders (n = 6) and quantifiable data collected as part of the intervention. Additional process data were extracted from a sub-set of qualitative interviews with participants and carers (n = 20). Data were analysed for process information related to context, recruitment and retention, reach, implementation, and fidelity. RESULTS Walk Well was not effective in significantly increasing levels of physical activity. The process evaluation did, however, highlight several important areas for consideration in future studies, including: a successful recruitment and retention strategy reaching a representative sample of adults with intellectual disabilities in the community; feasible and (for most) enjoyable methods of engaging adults with intellectual disabilities in activities to support behaviour change; potential need for greater intervention duration and frequency of contact; advantages and disadvantages of using pedometers as a behaviour change tool; the need for strategies which engage carers in supporting participants; and the complex issue of 'freedom of choice' in relation to lifestyle behaviours and study participation. CONCLUSIONS Walking interventions for adults with intellectual disabilities can be feasibly delivered in the community in relation to reach, recruitment, retention and intervention fidelity. More intensive intervention methods need to be explored as well as strategies to engage and motivate carers in their support of participants. TRIAL REGISTRATION Current Controlled Trials ISRCTN50494254 (3(rd) April 2012).
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Affiliation(s)
- Lynsay Matthews
- Institute of Health and Wellbeing, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland.
| | - Fiona Mitchell
- Department of Physical Activity for Health, University of Strathclyde, Glasgow, Scotland
| | - Kirsten Stalker
- Glasgow School of Social Work, University of Strathclyde, Glasgow, Scotland
| | - Alex McConnachie
- Institute of Health and Wellbeing, Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland
| | - Heather Murray
- Institute of Health and Wellbeing, Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland
| | - Chris Melling
- Social Work Services, Glasgow City Council, Glasgow, Scotland
| | - Nanette Mutrie
- Institute for Sport, Physical Education and Health Sciences, Moray House School of Education, University of Edinburgh, Edinburgh, Scotland
| | - Craig Melville
- Institute of Health and Wellbeing, Academic Unit for Mental Health & Wellbeing, University of Glasgow, Glasgow, Scotland
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Mitchell F, Jahoda A, Hankey C, Matthews L, Murray H, Melville C. 'Moving on and feeling good': a feasibility study to explore the lifestyle behaviours of young adults with intellectual disabilities as they transition from school to adulthood-a study protocol. Pilot Feasibility Stud 2016; 2:8. [PMID: 27965828 PMCID: PMC5154056 DOI: 10.1186/s40814-015-0044-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 12/31/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The transition from adolescence to adulthood is a 'high-risk' period for weight gain in the general population. There is speculation that this may also be a risk period for adults with intellectual disabilities; however, there has been no research which has monitored change in health indicators. Since adults with intellectual disabilities have higher rates of obesity and engage in more sedentary behaviour and less physical activity than the general population, there is a need to understand more about the lifestyle behaviours of this population during the transition to adulthood. This protocol paper will provide details of the moving on and feeling good feasibility study, designed for young people with intellectual disabilities. METHODS/DESIGN A multi-point recruitment strategy will be used to recruit 30 participants with a mild-moderate level of intellectual disability. The aim of the feasibility study is to examine the feasibility of recruitment, participant retention and the measurement of relevant health behaviour outcomes. The study will assess the feasibility of monitoring weight, diet and physical activity levels in adolescents over a 12-month transitional period from school to adult life. This mixed method study will provide insight into the lives of young people with intellectual disabilities and will examine the use of Walker et al.'s social-ecological approach to promote self-determination specific to lifestyle behaviours, during this transition period. Baseline data will be collected during the final year of school, with follow-up data collection at 6 and 12 months. Anthropometric (weight, height, waist and hip circumference), objective physical activity measures (7-day accelerometer wear) and dietary and choice measures will be collected at each time point to assess the feasibility of measuring diet patterns, food frequency, physical activity and BMI. Furthermore, ten participants will be selected for short semi-structured scoping interviews at baseline and 12-month follow-up, to gain information on psychological, social and environmental factors which might affect behaviour change. DISCUSSION The outcomes from the feasibility study will aid the development and piloting of a sufficiently powered randomised controlled trial. This would allow us to evaluate the effectiveness and sustainability of a lifestyle behaviour intervention, over a 5-year transition period.
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Affiliation(s)
- Fiona Mitchell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland UK
| | - Andrew Jahoda
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland UK
| | - Catherine Hankey
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland UK
| | - Lynsay Matthews
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland UK
| | - Heather Murray
- Institute of Health and Wellbeing, Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland UK
| | - Craig Melville
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland UK
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25
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Jones N, Melville CA, Harris L, Bleazard L, Hankey CR. A qualitative study exploring why adults with intellectual disabilities and obesity want to lose weight and views of their carers. BMC OBESITY 2015; 2:49. [PMID: 26693285 PMCID: PMC4683767 DOI: 10.1186/s40608-015-0080-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/09/2015] [Indexed: 11/19/2022]
Abstract
Background Obesity is more prevalent in adults with intellectual disabilities (ID) compared to the general population. Motivations for weight loss may influence engagement with weight management programmes and have only been studied in adults without ID. Aims: To determine reasons given by adults with ID and obesity for seeking weight loss and whether these reasons differ from those of their carers. Methods Prior to a multi-component weight management intervention, participants were asked “why do you want to lose weight?” Carers were asked their views and these were compared to the answers given by the adult with ID. Responses were themed. The Fisher’s Exact analysis was used to test for any relationship between reasons for seeking weight loss and participants’ level of ID, age, gender and BMI. Results Eighteen men and 32 women; age 41.6 SD 14.6 years; BMI 40.8 SD 7.5 kg/m2; Level ID Mild (28 %), Moderate (42 %), Severe (22 %), Profound (8 %). Eleven were unable to respond. Six themes emerged; Health; Fitness / Activity / Mobility; Appearance / Clothes; Emotional / Happiness; For Others; Miscellaneous. The most frequent reason given overall and by women was “appearance.” Carers cited “health” most frequently and “appearance” least, rarely agreeing with participants. “Health” was given as a reason more from older adults and those with milder ID. No statistically significant associations were found between reasons for seeking weight loss and BMI age, gender or level of ID but the differing views of adults with ID and their carers were clear. Conclusions Views of adults with obesity and mild or moderate ID can be collected. The opposing views of adults and their carers may affect motivation for weight loss.
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Affiliation(s)
- N Jones
- Mental Health and Wellbeing, University of Glasgow, 1st Floor Admin Building, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH UK
| | - C A Melville
- Mental Health and Wellbeing, University of Glasgow, 1st Floor Admin Building, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH UK
| | - L Harris
- Mental Health and Wellbeing, University of Glasgow, 1st Floor Admin Building, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH UK
| | - L Bleazard
- Mental Health and Wellbeing, University of Glasgow, 1st Floor Admin Building, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH UK
| | - C R Hankey
- Human Nutrition Section, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow, G31 2ER UK
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Cartwright L, Reid M, Hammersley R, Blackburn C, Glover L. Food choice by people with intellectual disabilities at day centres: A qualitative study. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2015; 19:103-115. [PMID: 25524597 DOI: 10.1177/1744629514563423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2014] [Indexed: 06/04/2023]
Abstract
People with intellectual disabilities experience a range of health inequalities. It is important to investigate possible contributory factors that may lead to these inequalities. This qualitative study identified some difficulties for healthy eating in day centres. (1) Service users and their family carers were aware of healthy food choices but framed these as diets for weight loss rather than as everyday eating. (2) Paid carers and managers regarded the principle of service user autonomy and choice as paramount, which meant that they felt limited in their capacity to influence food choices, which they attributed to the home environment. (3) Carers used food as a treat, a reward and for social bonding with service users. (4) Service users' food choices modelled other service users' and carers' choices at the time. It is suggested that healthy eating should be made more of a priority in day care, with a view to promoting exemplarily behaviour that might influence food choice at home.
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Spanos D, Hankey CR, Melville CA. The Effectiveness of a Weight Maintenance Intervention for Adults with Intellectual Disabilities and Obesity: A Single Stranded Study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2015; 29:317-29. [PMID: 25916495 DOI: 10.1111/jar.12181] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The evidence base for weight management programmes incorporating a weight loss and a weight maintenance phase for adults with intellectual disabilities (ID) is limited. This study describes the weight maintenance phase of a multicomponent weight management programme for adults with intellectual disability and obesity (TAKE 5). MATERIALS AND METHODS Thirty-one participants who had completed the 16 week TAKE five weight loss intervention (Phase I) were invited to participate in a 12 month weight maintenance intervention (Phase II). Content included recommendations of the National Weight Control Registry. RESULTS Twenty-eight participants completed Phase II with 50.4% maintaining their weight (mean weight change -0.5 kg, SD 2.2), 28.7% gaining weight (mean weight gain 5.4 kg, SD 2.2) and 21.6% losing weight (mean weight loss -8.0 kg, SD 3.0) at 12 months. CONCLUSION Further research is justified to investigate the efficacy of weight loss maintenance interventions in adults with intellectual disability and obesity, using controlled study designs.
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Affiliation(s)
- Dimitrios Spanos
- Institute of Mental Health & Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Catherine R Hankey
- College of Medical, Veterinary and Medical and Life Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Craig A Melville
- Institute of Mental Health & Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Martínez-Zaragoza F, Campillo-Martínez JM, Ato-García M. Effects on Physical Health of a Multicomponent Programme for Overweight and Obesity for Adults with Intellectual Disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2015; 29:250-65. [DOI: 10.1111/jar.12177] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2014] [Indexed: 12/01/2022]
Affiliation(s)
| | | | - Manuel Ato-García
- Department of Basic Psychology and Methodology; Faculty of Psychology; University of Murcia; Murcia Spain
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Sundblom E, Bergström H, Ellinder LS. Understanding the Implementation Process of a Multi-Component Health Promotion Intervention for Adults with Intellectual Disabilities in Sweden. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2015; 28:296-306. [DOI: 10.1111/jar.12139] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Elinor Sundblom
- Centre for Epidemiology and Community Medicine; Solna Sweden
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A single-blind, pilot randomised trial of a weight management intervention for adults with intellectual disabilities and obesity: study protocol. Pilot Feasibility Stud 2015; 1:5. [PMID: 27965785 PMCID: PMC5066520 DOI: 10.1186/2055-5784-1-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 12/22/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of obesity in adults with intellectual disabilities has consistently been reported to be higher than the general population. Despite the negative impact of obesity on health, there is little evidence of the effectiveness of weight management interventions for adults with intellectual disabilities and obesity. Preliminary results from a single-stranded feasibility study of a multi-component weight management intervention specifically designed for adults with intellectual disabilities and obesity (TAKE 5) and that satisfied clinical recommendations reported that it was acceptable to adults with intellectual disabilities and their carers. This study aims to determine the feasibility of a full-scale clinical trial of TAKE 5. METHODS This study will follow a pilot randomised trial design. Sixty-six obese participants (body mass index (BMI) ≥30 kg/m2) will be randomly allocated to the TAKE 5 multi-component weight management intervention or a health education 'active' control intervention (Waist Winners Too (WWToo)). Both interventions will be delivered over a 12-month period. Participants' anthropometric measures (body weight, BMI, waist circumference, percentage body fat); indicators of activity (levels of physical activity and sedentary behaviour) and well-being will be measured at three time points: baseline, 6 and 12 months. The researcher collecting outcome measures will be blind to study group allocation. CONCLUSIONS The data from this study will generate pilot data on the acceptability of randomisation, attrition rates and the estimates of patient-centred outcomes of TAKE 5, which will help inform future research and the development of a full-scale randomised clinical trial. TRIAL REGISTRATION ISRCTN52903778.
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Bennett AE, Cunningham C. A qualitative evaluation of a healthy cookery course in Ireland designed for adults with mild to moderate intellectual disability. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2014; 18:270-281. [PMID: 25099009 DOI: 10.1177/1744629514544074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Adults with an intellectual disability have poorer diets than the general adult population. The Able 2 Cook 4 Health cookery course aims to improve the diets of adults with mild to moderate intellectual disability. This study aims to evaluate the course by obtaining the views of course participants and the views of managers hosting the course. Thirty course participants took part in focus groups. Five managers hosting the course participated in a semi-structured interview. Positive features of the course included the group cooking, social interaction and course instructors. Collaboration between centres hosting the course and participants' home environment is needed to help transfer the skills learned to all home settings. The Able 2 Cook 4 Health cookery course provided participants with an important social outlet to learn essential occupational skills. These findings could particularly influence the diets of adults with an intellectual disability moving into independent living.
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Spanos D, Melville CA, Hankey CR. Weight management interventions in adults with intellectual disabilities and obesity: a systematic review of the evidence. Nutr J 2013; 12:132. [PMID: 24060348 PMCID: PMC3849062 DOI: 10.1186/1475-2891-12-132] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 09/10/2013] [Indexed: 11/16/2022] Open
Abstract
To evaluate the clinical effectiveness of weight management interventions in adults with intellectual disabilities (ID) and obesity using recommendations from current clinical guidelines for the first line management of obesity in adults. Full papers on lifestyle modification interventions published between 1982 to 2011 were sought by searching the Medline, Embase, PsycINFO and CINAHL databases. Studies were evaluated based on (1) intervention components, (2) methodology, (3) attrition rate (4) reported weight loss and (5) duration of follow up. Twenty two studies met the inclusion criteria. The interventions were classified according to inclusion of the following components: behaviour change alone, behaviour change plus physical activity, dietary advice or physical activity alone, dietary plus physical activity advice and multi-component (all three components). The majority of the studies had the same methodological limitations: no sample size justification, small heterogeneous samples, no information on randomisation methodologies. Eight studies were classified as multi-component interventions, of which one study used a 600 kilocalorie (2510 kilojoule) daily energy deficit diet. Study durations were mostly below the duration recommended in clinical guidelines and varied widely. No study included an exercise program promoting 225-300 minutes or more of moderate intensity physical activity per week but the majority of the studies used the same behaviour change techniques. Three studies reported clinically significant weight loss (≥ 5%) at six months post intervention. Current data indicate weight management interventions in those with ID differ from recommended practice and further studies to examine the effectiveness of multi-component weight management interventions for adults with ID and obesity are justified.
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Affiliation(s)
- Dimitrios Spanos
- College of Medical, Veterinary and Medical and Life Sciences, University of Glasgow, Glasgow G31 2ER, UK
- Learning Disabilities Psychiatry, College of Medical Veterinary and Life Sciences, Institute of Mental Health & Wellbeing, University of Glasgow, Glasgow G12 0XH, UK
| | - Craig Andrew Melville
- Learning Disabilities Psychiatry, College of Medical Veterinary and Life Sciences, Institute of Mental Health & Wellbeing, University of Glasgow, Glasgow G12 0XH, UK
| | - Catherine Ruth Hankey
- Human Nutrition, College of Medical, Veterinary and Medical and Life Sciences, University of Glasgow, Glasgow Royal Infirmary, Level 2, New Lister Building, Glasgow G31 2ER, UK
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Mitchell F, Melville C, Stalker K, Matthews L, McConnachie A, Murray H, Walker A, Mutrie N. Walk Well: a randomised controlled trial of a walking intervention for adults with intellectual disabilities: study protocol. BMC Public Health 2013; 13:620. [PMID: 23816316 PMCID: PMC3733830 DOI: 10.1186/1471-2458-13-620] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 06/24/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Walking interventions have been shown to have a positive impact on physical activity (PA) levels, health and wellbeing for adult and older adult populations. There has been very little work carried out to explore the effectiveness of walking interventions for adults with intellectual disabilities. This paper will provide details of the Walk Well intervention, designed for adults with intellectual disabilities, and a randomised controlled trial (RCT) to test its effectiveness. METHODS/DESIGN This study will adopt a RCT design, with participants allocated to the walking intervention group or a waiting list control group. The intervention consists of three PA consultations (baseline, six weeks and 12 weeks) and an individualised 12 week walking programme.A range of measures will be completed by participants at baseline, post intervention (three months from baseline) and at follow up (three months post intervention and six months from baseline). All outcome measures will be collected by a researcher who will be blinded to the study groups. The primary outcome will be steps walked per day, measured using accelerometers. Secondary outcome measures will include time spent in PA per day (across various intensity levels), time spent in sedentary behaviour per day, quality of life, self-efficacy and anthropometric measures to monitor weight change. DISCUSSION Since there are currently no published RCTs of walking interventions for adults with intellectual disabilities, this RCT will examine if a walking intervention can successfully increase PA, health and wellbeing of adults with intellectual disabilities. TRIAL REGISTRATION ISRCTN ISRCTN50494254.
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Affiliation(s)
- Fiona Mitchell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | - Craig Melville
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | - Kirsten Stalker
- Glasgow School of Social Work, University of Strathclyde, Glasgow, Scotland, UK
| | - Lynsay Matthews
- Physical Activity for Health Research Group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland, UK
| | - Alex McConnachie
- Institute of Health and Wellbeing, Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland, UK
| | - Heather Murray
- Institute of Health and Wellbeing, Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland, UK
| | - Andrew Walker
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland, UK
| | - Nanette Mutrie
- Institute for Sport, Physical Education and Health Sciences, Moray House School of Education, University of Edinburgh, Edinburgh, Scotland, UK
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Spanos D, Hankey C, Boyle S, Melville C. Comparing the effectiveness of a multi‐component weight loss intervention in adults with and without intellectual disabilities. J Hum Nutr Diet 2013; 27:22-9. [DOI: 10.1111/jhn.12051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- D. Spanos
- College of Medical Veterinary and Life Sciences University of Glasgow Glasgow UK
| | - C. Hankey
- College of Medical Veterinary and Life Sciences University of Glasgow Glasgow UK
| | - S. Boyle
- Glasgow and Clyde Weight Management Service NHS Greater Glasgow and Clyde Glasgow UK
| | - C. Melville
- College of Medical Veterinary and Life Sciences University of Glasgow Glasgow UK
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Beeken RJ, Spanos D, Fovargue S, Hunter R, Omar R, Hassiotis A, King M, Wardle J, Croker H. Piloting a manualised weight management programme (Shape Up-LD) for overweight and obese persons with mild-moderate learning disabilities: study protocol for a pilot randomised controlled trial. Trials 2013; 14:71. [PMID: 23497560 PMCID: PMC3605362 DOI: 10.1186/1745-6215-14-71] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 02/26/2013] [Indexed: 01/22/2023] Open
Abstract
Background National obesity rates have dramatically risen over the last decade. Being obese significantly reduces life expectancy, increases the risk of a range of diseases, and compromises quality of life. Costs to both the National Health Service and society are high. An increased prevalence of obesity in people with learning disabilities has been demonstrated. The consequences of obesity are particularly relevant to people with learning disabilities who are already confronted by health and social inequalities. In order to provide healthcare for all, and ensure equality of treatment for people with learning disabilities, services must be developed specifically with this population in mind. The aim of this project is to pilot the evaluation of a manualised weight management programme for overweight and obese persons with mild-moderate learning disabilities (Shape Up-LD). Methods/Design An individually randomised, controlled pilot trial in 60 overweight and obese (body mass index ≥ 25) adults (age ≥ 18) with mild-moderate learning disabilities and their carers will be carried out, comparing “Shape Up-LD” with usual care. The manualised Shape Up-LD intervention will involve 12 weekly sessions, which include healthy eating messages, advice on physical activity and use of behaviour change techniques to help people manage their weight. Assessments of participants will be conducted at baseline, 12 weeks and 6 months. Service users and their carers and service providers will also give their perspectives on the experience of Shape Up-LD in qualitative interviews at 12 weeks. Feasibility outcomes will include recruitment rates, loss to follow-up, compliance rates, completion rates, collection of information for a cost-effectiveness analysis and an estimation of the treatment effect on weight. Discussion The findings from this study will inform our preparation for a definitive randomised controlled trial to test the efficacy of the programme with respect to weight loss and maintenance in this population. Weight loss through Shape Up-LD could lead to improvements in health and quality of life. Costs to the National Health Service might be reduced through decreased overall service use because of improved health. The programme would also ensure a more equitable service for overweight service users with learning disabilities and fill the current gap in weight management services for this population. Trial registration International Standard Randomised Controlled Trial No ISRCTN39605930
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Affiliation(s)
- Rebecca J Beeken
- Department of Epidemiology & Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
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