Energy expenditure measured with accelerometers and self-report questionnaire in people with intellectual disabilities

Quantifying Physical Activity and Sedentary Behavior in Adults with Intellectual Disability: A Scoping Review of Assessment Methodologies

Background/Objectives: Methodologies for assessing behavior form the foundation of health promotion and disease prevention. Physical activity (PA) and sedentary behavior (SB) assessment methodologies have predominantly been developed for adults without an intellectual disability (ID), raising credibility concerns for adults with ID. The purpose was to synthesize the current state of assessment methodologies for quantifying PA and SB volume in the free-living setting for adults with an ID. Methods: Following PRISMA guidelines, eleven databases were searched through December 2023, yielding 8174 records. Data were extracted in Covidence (v.2.0), obtaining quantified PA and SB volume and assessment methodology characteristics across data collection and analysis, including tool(s) and technique(s) used, preparatory actions taken, instructions provided, and behavioral strategies employed during data collection. Results: Of the 8174 articles screened, 91 met the inclusion criteria. Common metrics included minutes/hours per day/week and steps per day/week. Despite 80% of the studies using objective techniques, substantial variation existed across studies regarding wearable models, sampling frequency and epoch length settings, calibration protocols, wearable placements, and data processing techniques. Limited studies provided instructions that did not exclusively rely on spoken language. Behavioral strategies varied, including self-monitoring, providing assistance or supervision, administering questionnaires verbally, issuing reminders, and offering monetary incentives. Conclusions: This review underscores the need for greater consistency and accessibility in PA and SB assessment methodology for adults with ID. Tailored preparation, instruction, and behavioral strategies may enhance assessment viability and suitability for adults with ID, with or without caregiver or researcher involvement in the free-living setting.

A Scoping Review of Wearable Technologies for Use in Individuals With Intellectual Disabilities and Diabetic Peripheral Neuropathy

BACKGROUND

Individuals with intellectual disabilities (IDs) are at risk of diabetes mellitus (DM) and diabetic peripheral neuropathy (DPN), which can lead to foot ulcers and lower-extremity amputations. However, cognitive differences and communication barriers may impede some methods for screening and prevention of DPN. Wearable and mobile technologies-such as smartphone apps and pressure-sensitive insoles-could help to offset these barriers, yet little is known about the effectiveness of these technologies among individuals with ID.

METHODS

We conducted a scoping review of the databases Embase, PubMed, and Web of Science using search terms for DM, DPN, ID, and technology to diagnose or monitor DPN. Finding a lack of research in this area, we broadened our search terms to include any literature on technology to diagnose or monitor DPN and then applied these findings within the context of ID.

RESULTS

We identified 88 articles; 43 of 88 (48.9%) articles were concerned with gait mechanics or foot pressures. No articles explicitly included individuals with ID as the target population, although three articles involved individuals with other cognitive impairments (two among patients with a history of stroke, one among patients with hemodialysis-related cognitive changes).

CONCLUSIONS

Individuals with ID are not represented in studies using technology to diagnose or monitor DPN. This is a concern given the risk of DM complications among patients with ID and the potential for added benefit of such technologies to reduce barriers to screening and prevention. More studies should investigate how wearable devices can be used among patients with ID.

Reactivity to accelerometer measurement of youth with moderate and severe intellectual disabilities

BACKGROUND

Reactivity occurs when research participants alter their behaviours due to the awareness of being monitored, which is a concern with using wearable devices to measure physical activity. The purpose of this study was to examine reactivity to accelerometer measurement among youth with moderate and severe intellectual disabilities (ID).

METHODS

A sample of 175 youth with ID (108 with moderate and 67 with severe ID) was recruited from residential centres in China. Demographic data were measured using a parent-reported questionnaire, and light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) were measured using the ActiGraph GT3X accelerometers. Data were analysed using an analysis of covariances where Day 1 LPA/MVPA, Day 2-6 LPA/MVPA, and Day 7 LPA/MVPA were repeated measures.

RESULTS

Youth with moderate ID had significantly higher LPA (8.01%) and MVPA (10.30%) on Day 1 than Day 2-6. Similarly, youth with severe ID had significantly higher LPA (21.69%) and MVPA (19.48%) on Day 1 than Day 2-6. An inverse reactivity was also found on Day 7 among youth with severe ID for LPA (-10.65%) and MVPA (-14.82%).

CONCLUSIONS

Reactivity to accelerometer measurement was found for youth with moderate and severe ID. Findings support the utilisation of a 1-day familiarisation period, as well as discounting the final day of measurement, when examining physical activity behaviours among youth with moderate and severe ID.