The effects of physical activity or sport-based interventions on psychological factors in adults with intellectual disabilities: a systematic review

The impact of leisure physical activity on the physical fitness of young adults with intellectual disabilities

BACKGROUND

Individuals with intellectual disability are less physically active than individuals without intellectual disabilities, and rarely reach the recommended daily level of physical activity. There is sufficient scientific evidence for the beneficial effects of exercise on the cardiovascular and muscular fitness of young adults with mild-to-moderate intellectual disabilities.

THE AIM

To assess the impact of leisure physical activity on the physical fitness of adults with intellectual disabilities.

METHOD

21 people (35,4 ± 11,61 years) with intellectual disabilities were allocated to two groups: I group (mean age 32,14 ± 9 years, 2 months, 1 t/week) and group II (mean age 38,25 ± 13,39 years, 2 months, 2 t/week). At the baseline and at the end of the intervention, the cardiorespiratory fitness, lower-body muscular strength and endurance, mobility and balance were assessed with 6-min walking (6MWT), lateral step-up (LSUT), sit-to-stand (30CST), Timed Up and Go (TUG) and Tinetti balance tests.

RESULTS

Both groups showed improvements in cardiorespiratory endurance, muscular strength, and balance. Significant improvements were observed in Group I in the TUG (p = 0.002), LSUT (p = 0.001), and 6MWT (p = 0.004) results. Group II also demonstrated progress in TUG (p = 0.010), LSUT (p = 0.008), and 6MWT (p = 0.012), though they did not reach recommended physical activity benchmarks. Significant differences between the groups were observed in leg strength and mobility (p < 0.05). These findings suggest that short-term, low-frequency interventions may be insufficient for individuals with low baseline fitness.

CONCLUSION

This study fills a gap in the literature by focusing on young adults with ID and shows that leisure PA can yield meaningful functional improvements. However, higher frequency and longer-duration interventions are likely needed to achieve recommended physical activity levels. The findings offer practical insights for developing inclusive, evidence-based PA programs for this underserved population.

LAY SUMMARY

For individuals with intellectual disabilities, physical capability is often assessed through abilities essential to daily living-such as coordination, balance, muscular strength, endurance, and flexibility. As people age, functional strength and exercise tolerance tend to decline. This study showed that in young adults with mild to moderate intellectual disabilities, leisure physical activity improves fitness and mobility and can reduce some cardiovascular risk factors. Programs should prioritize exercises that improve gait, balance, and physical function to lower fall risk and support greater independence. These findings highlight that leisure physical activity is a simple, cost-effective way to promote health in this population.

Measures of emotional well-being for individuals with intellectual disabilities: A scoping review of reviews

OBJECTIVE

This scoping review of reviews examines how one facet of quality of life, emotional well-being (EWB), has been assessed for individuals with intellectual disabilities (ID), including the characteristics of measures that have been designed, adapted, or administered to individuals in this population.

METHODS

Following established practices for scoping reviews, we searched the ERIC, APA Psych Info, and Academic Search Premier databases in November 2022 for review articles that included measures of EWB that had been designed, adapted, or administered to individuals with ID. Following PRISMA guidelines, we conducted independent double coding at the title and abstract and full text review stages. From each included review article, we extracted the review's purpose, EWB-related construct of interest, and EWB-related measure names and authors. We then located each measure and coded its items using Park et al.'s (2023) definition of EWB. We also coded the "non-EWB" domains assessed by these measures. We used the PRISMA Extension for Scoping Reviews (PRISMA-Scr) checklist to structure our manuscript.

RESULTS

The scoping review identified 10 review articles that included 14 unique measures of EWB. Each of these measures included at least 1 item (M = 2.8) that assessed EWB. Quality of life was the most common EWB-related construct specified by review articles. Measures frequently assessed additional constructs beyond EWB, including self-determination, interpersonal relations, physical well-being, and material well-being.

CONCLUSIONS

In measures designed or adapted for individuals with ID, EWB is often included as a subcomponent of quality of life. Because of EWB's link to positive social, emotional, behavioral, and health outcomes, research is needed to identify the most salient components of EWB for individuals with ID. This would allow for measures and interventions to be developed to promote EWB in this population.

WHAT THIS PAPER ADDS

This study provides a scoping review of available measures of EWB that have been designed, adapted, or administered to individuals with ID. Study findings detail the characteristics of these measures, highlighting gaps in available EWB measures for children and adolescents with ID. We also found that emotional well-being is frequently assessed as a component of a broader construct (e.g., quality of life) using a small number of items. This suggests a need and opportunity for growth in further understanding emotional well-being assessment in individuals with ID.

A Systematic Review of Community-Based Exercise Interventions for Adults with Intellectual Disabilities

Background: Adults with intellectual disabilities are a particularly inactive sub-population who experience disproportionally poorer health and social exclusion when compared with the wider general population. This systematic review aimed to identify whether community-based exercise interventions were theoretically underpinned, whether they had an active single- or multi-exercise component, and how the interventions were objectively and/or subjectively measured, as well as deducing if they improved the health of this population. Method: A systematic search of five databases was conducted up to May 2024. The study was registered in PROSPERO and followed PRISMA reporting guidelines. Study methodological quality was appraised using the Critical Appraisal Skills Programme. Risk of bias was determined using the Cochrane collaboration tools ROB 2 and ROB 2 CRT. Articles were eligible for inclusion if they recruited adults with intellectual disability, were community-based, had an active exercise component and measured physical activity (PA) levels as an outcome measure. Results: In total, 9034 records were identified, with five studies meeting the eligibility criteria. All studies used a feasibility RCT or RCT methodology and all focused on weight loss or PA levels as the primary outcome measure. Two studies focused on walking as a single exercise, two combined walking with nutrition/weight loss, and one combined walking with aerobics. One multi-component walking and aerobics intervention led to statistically significant improvements in PA. Multi-component community-based exercise interventions led to statistically significant improvements in body composition measures. No studies showed statistically significant improvements in quality of life. Risk of bias was rated moderate to high across all included studies. Conclusions: Caution should be taken in drawing firm conclusions due to the small number of included studies, small sample sizes and high risk of bias. Multi-component community-based interventions are more effective at improving PA levels in adults with intellectual disabilities than walking-only studies. Future studies should be theoretically underpinned and explore the use of peer and student models of social support. The use of fitness facilities such as leisure centres and gyms requires further exploration in this population.

Understanding the effectiveness and underlying mechanisms of lifestyle modification interventions in adults with learning disabilities: a mixed-methods systematic review

Background

Adults with learning disabilities face increased risks of unhealthy lifestyle behaviours, including alcohol consumption, smoking, low physical activity, sedentary behaviour and poor diet. Lifestyle modification interventions that target health-risk behaviours can prevent or reduce their negative effects. The goal of this project was to investigate the effectiveness and underlying mechanisms of lifestyle modification interventions in adults with learning disabilities.

Methods

A systematic review and meta-analysis were conducted to determine the effectiveness of lifestyle modification interventions and their components in targeting health risk behaviours in adults with learning disabilities. Major electronic databases, clinical trial registries, grey literature, and citations of systematic reviews and included studies were searched in January 2021 (updated in February 2022). We included randomised and non-randomised controlled trials targeting alcohol consumption, smoking, low physical activity only, sedentary behaviour and poor diet in adults (aged ≥ 18 years) with learning disabilities. Studies were also coded based on the extent of use of theories and behaviour change techniques in interventions. Risk of bias in studies was assessed using appropriate tools. A realist synthesis of qualitative, quantitative and mixed-methods literature was conducted to complement the systematic review findings by identifying key intervention mechanisms that are likely to improve the health of adults with learning disabilities. Data were synthesised in the form of a programme theory regarding complex causal mechanisms and how these interact with social context to produce outcomes. All findings were integrated into a logic model. A patient and public involvement group provided input and insights throughout the project.

Results

A total of 80 studies with 4805 participants were included in the systematic review. The complexity of lifestyle modification interventions was dismantled by identifying six core components that influenced outcomes. These components could be present in interventions targeting single or multiple health risk behaviors, either as individual elements or in various combinations. Interventions on alcohol and smoking behaviours were found to be effective, but this was based on limited evidence. The effectiveness of interventions targeting low physical activity only or multiple behaviours (low physical activity only, sedentary behaviours and poor diet) was mixed. All interventions had a varying level of statistical significance. The intervention-level network meta-analysis for weight management outcomes showed none of the interventions was associated with a statistically significant change in outcomes when compared to treatment as usual and each other. Similar findings were observed in the component network meta-analysis. A variety of theories and behaviour change techniques were employed in the development and adaptation of interventions. Most studies had a high and moderate risk of bias. A total of 79 studies, reporting the experiences of more than 3604 adults with intellectual disabilities and over 490 caregivers, were included in the realist synthesis. The resulting programme theory highlighted the contexts and mechanisms relating to support involvement, negotiating the balance between autonomy and behaviour change, fostering social connectedness and fun, the accessibility and suitability of intervention strategies and delivery, along with the broader behavioural pathways to lifestyle change. It also brought out the importance of working with people with lived experiences when developing and evaluating interventions. Our logic model, bringing together the findings of both syntheses, provides guidance on the design of future interventions.

Discussion

This study was the first comprehensive mixed-methods evidence synthesis to explore lifestyle modification interventions targeting multiple unhealthy lifestyle behaviours in adults with learning disabilities. We conclude that future research could benefit from codeveloping interventions and population-specific assessment frameworks with people with lived experiences. There is a need for more high-quality research with appropriate outcomes and a focus on qualitative and mixed-methods research to better understand what works for whom and why.

Trial registration

This trial is registered as PROSPERO CRD 42020223290.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR128755) and is published in full in Health Technology Assessment; Vol. 29, No. 4. See the NIHR Funding and Awards website for further award information.

Do People with Intellectual Disabilities Have a Better Quality of Life If They Are Physically Active?

In the context of the practice of physical sports activities (PSA), people with intellectual disabilities (PID) have up to a 62% lower possibility of responding to internationally agreed-upon physical activity requirements, showing a higher risk of presenting serious health problems. This study aimed to analyze the levels of perception towards the latent construct of quality of life that a PID who practices PSA would have with respect to those PIDs who do not practice PSA. The sample consisted of 371 PIDs, of whom 278 practiced PSA and 93 did not practice PSA. The instrument used for data collection was the INICO-FEAPS scale. Methodologically, 12 binary logistic regression models were fitted. The results identify greater possibilities of perception by PIDs who perform DFA at the level of self-determination (4.88 OR), rights (5.0 OR), social inclusion (2.06 OR), personal development (2.80 OR), interpersonal relationship (3.19 OR), material well-being (4.41 OR) and quality of life (3.97 OR). Furthermore, when grouping the dimensions by independence (3.67 OR), social (4.34 OR) and well-being (3.91 OR), the odds were favourable toward those PIDs performing PSA. In conclusion, PIDs who perform PSA may present greater possibilities of having the quality of life construct.

Effectiveness of dynamic neuromuscular stabilization training on strength, endurance, and flexibility in adults with intellectual disabilities, a randomized controlled trial

Individuals with intellectual disabilities (ID) often exhibit lower levels of physical fitness compared to the general population, including reduced strength, endurance, flexibility, and coordination. Dynamic neuromuscular stabilization (DNS) training can potentially improve the performance of adults with ID caused by weak motor skills due to a lack of desirable nerve growth during childhood and before puberty. Also, DNS training proposed to improve physical fitness in this population, but the effectiveness and durability of DNS training on specific fitness components have not been well-established. This study employed a randomized controlled trial design to investigate the effects of an 8-week DNS training program on the strength, endurance, and flexibility of adults with ID. A total of 31 participants were randomly assigned to either an intervention group (n = 16) or a control group (n = 15). Muscular strength, endurance, and flexibility were assessed at baseline (pre-test), immediately after the intervention (post-test), and 2 months following the intervention (follow-up) using the 30-second chair stand (30sCS) test, sit-ups test, trunk lift test, and chair sit-and-reach test. Participants in the intervention group engaged in the DNS training program for 8 weeks, with 3 sessions per week, while the control group maintained their usual activities. The analysis of the outcome measures revealed significant time, group, and time-group interaction effects. Post-hoc analyses indicated that the DNS group exhibited significantly greater improvements in 30sCS, sit-ups, trunk lift, and chair sit-and-reach compared to the control group (p < 0.01). These improvements were maintained at the 2-month follow-up assessment in the DNS group. This randomized controlled trial demonstrates that an 8-week DNS training program significantly improves muscular strength, endurance, and flexibility in adults with ID, with benefits maintained at a 2 month follow-up. Further research is needed to replicate these findings and investigate underlying mechanisms, but the study highlights the potential of DNS training to promote physical fitness and well-being in individuals with ID.Trial registration RTC, prospectively registered in the Clinical Trial Registry (UMIN000053560) on 24/03/2024.

Satisfying basic psychological needs through a recreational sports programme for people with intellectual disability: human growth and adapted sport in focus

Introduction

Self-determination theory (SDT) highlights the importance of satisfying people's basic psychological needs (BPN) (autonomy, competence and relatedness) in order to ensure their personal growth and wellbeing. In this regard, sport and physical activity (PA) have been shown to offer significant health benefits, particularly in the case of people with intellectual disability (ID), among whom the benefits are even more noticeable owing to their low levels of PA, sedentary lifestyle, limited opportunities to exercise, and consequently lower quality of life. The aim of this study is to assess the impact of the Más Que Tenis ("More Than Just Tennis") inclusive recreational sports programme on the satisfaction of BPN among athletes with ID, taking into account factors such as age, gender and type of activity.

Methods

The sample for the study comprised 50 athletes (68% male) with ID (IQ: X = 54.33; sd = 13.43), aged 17-54 years. Data were collected using the Spanish version of the Basic Psychological Needs in Exercise Scale (BPNES), Kaufman Brief Intelligence Test (K-BIT), Satisfaction With Life Scale (SWLS), multidimensional AF5 self-concept scale, Vineland-3 Scale, and MABC-2 observation checklist.

Results

High levels of satisfaction of all three BPN, with autonomy scoring lowest of the three. Gender was found to be a significant predictor, with men scoring higher in all BNP. Participants reported positive perceptions in relation to physical self-concept and satisfaction with life. In terms of adaptive behaviour, deficits were detected in relation to communication and daily living skills, but not in relation to interpersonal skills. With respect to motor behaviour, satisfaction of BPN was found to correlate more with dynamic environments than with static ones. The findings indicate the effectiveness of the Más Que Tenis programme in satisfying the BPN of people with ID. Participants reported improved physical skills, competence, social integration and interpersonal relations, though also insufficient autonomy in relation to choosing what exercises to do.

Conclusion

Satisfaction of BPN through the programme was found to correlate positively with athletes' satisfaction with life and adaptive development, leading to improved personal and neuropsychological wellbeing.

Participation in Special Olympics reduces the rate for developing diabetes in adults with intellectual and developmental disabilities

AIM

Adults with intellectual and developmental disabilities (IDD) have a significantly higher prevalence of Type 2 diabetes than the general population. Evidence that lifestyle and/or behavioural interventions, such as participation in Special Olympics, decreases the risk of developing diabetes in adults with IDD could help minimize health disparities and promote overall health in this population.

METHODS

This was a 20-year retrospective cohort study of adults with IDD (30-39 years) in the province of Ontario, Canada, that compared hazard rates of diabetes among Special Olympics participants (n = 4145) to non-participants (n = 31,009) using administrative health databases housed at ICES. Using cox proportional hazard models, crude and adjusted hazard ratios were calculated for the association between the primary independent variable (Special Olympics participation status) and the dependent variable (incident diabetes cases).

RESULTS

After controlling for other variables, the hazard ratio comparing rates for developing diabetes between Special Olympics participants and non-participants was 0.85. This represents a 15% reduction in the hazard among Special Olympics participants when followed for up to 20 years. This result was statistically significant and represents a small effect size.

CONCLUSIONS

Special Olympics could be considered a complex intervention that promotes physical activity engagement through sport participation, health screenings, and the promotion of healthy eating habits through educational initiatives. This study provides evidence that Special Olympics participation decreases the rate for developing diabetes.

Behavioral weight loss interventions for people with physical disabilities: A systematic review

AIM

The aim of this study is to examine which interventions lead to clinically significant weight loss among people with physical disabilities.

METHODS

We systematically searched three electronic databases (PubMed, Scopus, and CENTRAL) including studies until May 2022 to find randomized controlled trials on behavioral interventions and weight-related outcomes in people with physical disabilities. Pharmacological or surgical interventions were excluded. Study quality was evaluated using the Cochrane Risk of Bias Tool. Interventions were grouped as dietary, physical activity, education/coaching, or multi-component. Mean weight changes, standard deviations, confidence intervals, and effect sizes were extracted or calculated for assessment of the intervention effect.

RESULTS

Sixty studies involving 6,511 participants were included in the qualitative synthesis. Most studies (n = 32) included multi-component interventions, incorporating dietary and physical activity components. Limited evidence suggests that extensive dietary interventions or long-term multi-component interventions might lead to a clinically relevant weight reduction of at least 5% for older individuals (age > 50) with mild-to-moderate mobility impairments.

DISCUSSION

Due to the high heterogeneity of studies and low study quality, it can be assumed that the range of applicability of the findings is questionable. Further research should examine younger age groups (i.e., children, adolescents, and adults under 40 years) and compare different settings such as schools, clinics, nursing homes, and assisted living facilities.

Lifestyle modification interventions for adults with intellectual disabilities: systematic review and meta-analysis at intervention and component levels

BACKGROUND

Adults with intellectual disabilities (IDs) are susceptible to multiple health risk behaviours such as alcohol consumption, smoking, low physical activity, sedentary behaviour and poor diet. Lifestyle modification interventions can prevent or reduce negative health consequences caused by these behaviours. We aim to determine the effectiveness of lifestyle modification interventions and their components in targeting health risk behaviours in adults with IDs.

METHODS

A systematic review and meta-analysis were conducted. Electronic databases, clinical trial registries, grey literature and citations of systematic reviews and included studies were searched in January 2021 (updated February 2022). Randomised controlled trials and non-randomised controlled trials targeting alcohol consumption, smoking, low physical activity, sedentary behaviours and poor diet in adults (aged ≥ 18 years) with ID were included. Meta-analysis was conducted at the intervention level (pairwise and network meta-analysis) and the component-level (component network meta-analysis). Studies were coded using Michie's 19-item theory coding scheme and 94-item behaviour change taxonomies. Risk of bias was assessed using the Cochrane Risk of Bias (ROB) Version 2 and Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I). The study involved a patient and public involvement (PPI) group, including people with lived experience, who contributed extensively by shaping the methodology, providing valuable insights in interpreting results and organising of dissemination events.

RESULTS

Our literature search identified 12 180 articles, of which 80 studies with 4805 participants were included in the review. The complexity of lifestyle modification intervention was dismantled by identifying six core components that influenced outcomes. Interventions targeting single or multiple health risk behaviours could have a single or combination of multiple core-components. Interventions (2 RCTS; 4 non-RCTs; 228 participants) targeting alcohol consumption and smoking behaviour were effective but based on limited evidence. Similarly, interventions targeting low physical activity only (16 RCTs; 17 non-RCTs; 1413 participants) or multiple behaviours (low physical activity only, sedentary behaviours and poor diet) (17 RCTs; 24 non-RCTs; 3164 participants) yielded mixed effectiveness in outcomes. Most interventions targeting low physical activity only or multiple behaviours generated positive effects on various outcomes while some interventions led to no change or worsened outcomes, which could be attributed to the presence of a single core-component or a combination of similar core components in interventions. The intervention-level meta-analysis for weight management outcomes showed that none of the interventions were associated with a statistically significant change in outcomes when compared with treatment-as-usual and each other. Interventions with core-components combination of energy deficit diet, aerobic exercise and behaviour change techniques showed the highest weight loss [mean difference (MD) = -3.61, 95% credible interval (CrI) -9.68 to 1.95] and those with core-components combination dietary advice and aerobic exercise showed a weight gain (MD 0.94, 95% CrI -3.93 to 4.91). Similar findings were found with the component network meta-analysis for which additional components were identified. Most studies had a high and moderate risk of bias. Various theories and behaviour change techniques were used in intervention development and adaptation.

CONCLUSION

Our systematic review is the first to comprehensively explore lifestyle modification interventions targeting a range of single and multiple health risk behaviours in adults with ID, co-produced with people with lived experience. It has practical implications for future research as it highlights the importance of mixed-methods research in understanding lifestyle modification interventions and the need for population-specific improvements in the field (e.g., tailored interventions, development of evaluation instruments or tools, use of rigorous research methodologies and comprehensive reporting frameworks). Wide dissemination of related knowledge and the involvement of PPI groups, including people with lived experience, will help future researchers design interventions that consider the unique needs, desires and abilities of people with ID.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Initiatives to facilitate the social inclusion of people with intellectual disability in physical activities with others in community-based sporting, recreation and leisure activities: A scoping review

BACKGROUND

While barriers to participation in physical activity are well documented, there is no consolidated evidence on strategies promoting participation of people with intellectual disability in physical activities.

METHODS

We conducted a scoping review to examine initiatives used to facilitate the inclusion of people with intellectual disability in community-based sporting and recreation activities. We searched Medline, Embase, CINAHL+ and PsycINFO for articles published in English between 2000 and 2022.

RESULTS

Eight articles were included. Initiatives included: (1) building knowledge, awareness and attitudinal change (2) organisational alliances/partnerships (3) relationship-building (4) modifications/adaptions to activities/environment (5) organisational policy (6) engagement with people with disability. Initiatives were implemented through international collaborations, in local fitness/recreational facilities and public spaces, and targeted athletes, coaches, volunteers and organisational leaders.

CONCLUSION

While some increase in awareness and inclusion of people with intellectual disability was reported, no longitudinal data reported on the impact of initiatives on sustained social inclusion for people with intellectual disability.

Safeguarding strategies in athletes with intellectual disabilities: A narrative review

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

Increasing physical activity through an adapted web-based exercise program for people with intellectual disabilities: Support staff are crucial for feasibility

BACKGROUND

People with intellectual disabilities are less physically active and suffer from ill-health more than the general population. Support staff play an important role in the person's life. This study aimed to explore the support staff's experiences regarding the feasibility of adapted web-based exercise for people with intellectual disabilities.

METHOD

Participants with intellectual disabilities living in community-based settings were recruited for a web-based exercise study. Eight semi-structured interviews were carried out with their support staff before and after the intervention period.

RESULTS

The main theme, 'Support staff are crucial for feasibility' encompasses the importance of communication, structure, and motivation in improving physical activity for people with intellectual disabilities.

CONCLUSION

The experiences of support staff, indicate that a web-based exercise program is feasible for the target group, and one way to overcome challenges for PA, where the role of the staff is crucial.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Young adults with intellectual and developmental disabilities who participate in Special Olympics are less likely to be diagnosed with depression

PURPOSE

People with intellectual and developmental disabilities (IDD) experience high rates of depression. Evidence indicates that physical activity, or participation in a sports club, in a supportive social environment has mental and physical health benefits. Adults with IDD, on average, engage in low levels of physical activity. The purpose of this study was to compare the rates of depression among young adult Special Olympics participants with IDD compared to non-participants with IDD.

METHODS

This was a 20-year retrospective cohort study of young adults (19-29 years) with IDD in the province of Ontario, Canada that compared rates of depression among Special Olympics participants (n = 8710) to non-participants (n = 42,393) using administrative health databases housed at ICES (formerly the Institute for Clinical Evaluative Sciences). Using cox proportional hazard models, the crude hazard ratios were calculated for the association between each independent variable and the dependent variable.

RESULTS

After controlling for other variables, the hazard rate for depression among Special Olympics participants compared to the hazard rate for depression among non-participants generated an adjusted hazard ratio of 0.51. Over the 20-year follow-up, the participants were 0.51 times as likely to develop depression as non-participants; this represents a 49% reduction in risk among Special Olympics participants. This result was statistically significant and represents a medium effect size.

CONCLUSION

Future research is needed on how much of this risk reduction is related to a physiological response to physical activity/exercise, and how much is related to the social connectedness of being part of a group participating in Special Olympics.

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

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

Exploring sport participation in individuals with spinal cord injury: A qualitative thematic synthesis

CONTEXT

Individuals with spinal cord injury (SCI) are susceptible to various physical, psychological, and social challenges. Sport is an activity that may holistically address these concerns. No existing research provides an overview of the current landscape of SCI-specific sport participation.

OBJECTIVE

To synthesize the findings of qualitative studies exploring the perceptions of people with SCI participating in sport, in relation to physical, psychological, and social health.

METHODS

This thematic synthesis included studies published in APA PsycInfo, CINAHL, Embase, Emcare, Medline, and PubMed. Eligible articles studied adults who had a SCI for ≥12 months and explored experiences following ≥3 months of sport participation using qualitative or mixed-methods. Articles were excluded if participants with SCI composed less than one-third of the study sample. From 8473 unique titles and abstracts screened, 47 articles underwent full-text review and 14 articles were included. The Mixed Methods Appraisal Tool was used to critically appraise the 13 qualitative studies and one mixed-methods study.

RESULTS

The overarching theme was that sport facilitates the progression to living an enriching life with SCI. Four sub-themes were identified within this theme: adjusting to SCI, factors influencing sport initiation, outcomes resulting from sport participation, and reshaping views of SCI. Participants detailed many benefits of sport, including improved fitness, independence, confidence, and sense of community. Beyond the participants themselves, sport helped reshape views of SCI by breaking stereotypes and inspiring others.

CONCLUSION

Sport can play a crucial role in facilitating the progression to living an enriching life following SCI.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Increased physical activity, higher educational attainment, and the use of mobility aid are associated with self-esteem in people with physical disabilities

Background

High self-esteem can help people with disabilities overcome barriers and improve their mental health and well-being. This study sought to examine self-esteem levels among Saudis with physical disabilities based on socio-economic factors. It also aimed to determine the minimum weekly duration of physical activity performed by participants and examine its effects, along with those of other socio-economic factors, on participants' self-esteem.

Methods

A participant sample (N = 582) consisting of Saudi individuals aged 33.78 ± 9.81 years with physical disabilities (males, n = 289; females, n = 293) was recruited to participate in this study. Levels of self-esteem were measured using the Arabic version of the Rosenberg Self-Esteem Scale.

Results

Compared to women, men demonstrated significantly higher levels of overall self-esteem, positive feelings, and negative feelings (p < 0.01). The respondents' average levels of overall self-esteem (p < 0.001), positive feelings (p < 0.01), and negative feelings (p < 0.001) also varied by type of physical disability. Wheelchair-using participants had the highest values for self-esteem and positive feelings; cane-using participants or those who did not use mobility aids had the lowest values. Weighted least squares regression showed that weekly physical activity was the factor that most affected self-esteem (β = 0.002), followed by education level (β = 0.115), then type of mobility device used (β = -0.07).

Conclusion

Increased weekly physical activity, higher education levels, and the use of mobility aids were the factors likely to improve the self-esteem of Saudis with physical disabilities.

The demographic and disability characteristics of individuals who regularly attend an urban adaptive fitness center: An observational study

INTRODUCTION

While it is well known that regular physical activity provides significant physical and psychosocial health benefits, people with disabilities have disproportionately lower rates of exercise compared to the able-bodied population. Reduced levels of physical activity can put this population at an increased risk of chronic health conditions, highlighting the importance of ensuring that our communities have accessible adaptive fitness opportunities.

OBJECTIVES

To evaluate the demographic and disability characteristics in individuals who regularly attend a specialized urban adaptive fitness center, to provide foundational understanding about the population that uses such resources.

DESIGN

Cross-sectional study SETTING: Specialized urban adaptive fitness center PARTICIPANTS: Sixty-three (n = 63) participants who regularly attend an urban Adaptive Sports and Fitness Center INTERVENTION: Not applicable MAIN OUTCOME MEASURE: World Health Organization (WHO) Disability Assessment Schedule (WHODAS) 2.0, evaluating disability in six domains: cognition, mobility, self-care, getting along, life activities, and participation. Results were converted into scores ranging from 0 (no disability) to 100 (total disability) and compared to WHO published norms for the general population and a demographics intake form.

RESULTS

Participants with mean age of 52.9 ±14.3 years were grouped into three diagnostic categories: spinal cord injury (30.2%), traumatic brain injury/stroke (36.5%), and other neurologic disease/chronic medical disease (33.3%). A total of 45.9% live alone, 96.8% exercise at least twice/week, and 43.5% participate in adaptive sports. Participants travel 8.0 miles on average for attendance. WHODAS disability summary score was 26.48 (86th percentile).

CONCLUSIONS

Although adaptive fitness center participants had a higher level of disability than 80% to 90% of the general population, regular participation was realistic and feasible. Further understanding of the barriers in those who do not engage in such facilities is needed.

The relationship between direct care providers' physical activity behaviour and perceived physical activity needs for people with intellectual disabilities

BACKGROUND

The promotion of physical activity and the decrease of inactivity and sedentary behaviour are crucial for a healthy lifestyle and positive quality of life. People with intellectual disabilities are at increased risk of inactivity and sedentary behaviour. Therefore, it is important to increase their physical activity by implementing physical activity guidelines in their daily life. Professional direct care providers can play a decisive role in supporting people with intellectual disabilities to participate in physical activity, but the engagement of direct care providers with this role may be reflective of their own attitudes and beliefs towards physical activity. Therefore, the link between the implementation of current physical activity guidelines for people with intellectual disabilities and direct care providers' own beliefs and behaviour with regard to physical activity is investigated.

METHOD

A total of 104 direct care providers completed self-reported questionnaires about their own physical activity behaviour (IPAQ-SF), recommendations for people with intellectual disabilities (adaption of EMIQ-HP) and questions regarding global physical activity guidelines. They were also asked about potential barriers and facilitators for the recommendation of physical activity in open-ended questions.

RESULTS

Personal physical activity behaviour is related to the recommended physical activity for people with intellectual disabilities (moderate-to-vigorous physical activity: r_s  = 0.408, P = 0.005). However, recommended physical activity behaviour for people with intellectual disabilities is significantly lower than direct care providers' own physical activity behaviour (P < 0.001). 47.1% of the respondents recommended people with intellectual disabilities to participate in less than the 150 min of moderate intensity physical activity per week for that is recommended in global physical activity guidelines.

CONCLUSION

Direct care providers may hold stereotypical views and insecurities about the potential harms associated with people with intellectual disabilities participating in physical activity. Therefore, the dissemination of physical activity recommendations for people with intellectual disabilities should be a major target for health professionals, social workers and scientists to address direct care providers' concerns. Furthermore, we need to emphasise the benefits of regular physical activity to professional direct care providers and directly to people with intellectual disabilities.

Web-based training intervention to increase physical activity level and improve health for adults with intellectual disability

BACKGROUND

Individuals with intellectual disability (ID) are less physically active, have a higher body mass index (BMI) and are at greater risk for cardiovascular diseases (CVDs) than people without ID. The purpose of the study was to explore the effectiveness of a web-based training programme, consisting of 150 min of activity per week, on the health of people with ID.

METHOD

Participants with ID living in supported accommodation (n = 28, 48% female, age = 36.4 ± 9.56 years) participated in a web-based training programme, consisting of a combination of exercises (endurance, strength balance and flexibility) of moderate intensity, 50 min, three times per week for 12 weeks. The body composition and waist circumference (WC) were measured, and questionnaires were used to assess enjoyment, quality of life (QoL) and physical activity (PA) level. Descriptive statistics and pairwise comparison pre and post intervention were carried out.

RESULTS

A total of 22 out of 28 participants completed the 12-week training intervention with 83% mean attendance of training sessions. The intensity of the PA level increased and a decrease in fat mass of 1.9 ± 2.4 kg, P < 0.001 and WC of 3 ± 5 cm, P = 0.009 were observed. Enjoyment of training sessions was 3.9 out of 5, and no differences in QoL were found.

CONCLUSION

A web-based training programme is an effective tool for improving health parameters of people with ID and offers a new way for caregivers to enhance the PA for the target group.

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

PURPOSE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

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

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

Developing social skills and self-satisfaction of adults with intellectual disabilities through sports: a parental perspective

The purpose of the study was to investigate the effects of sports activities on social skills and self-satisfaction in adults with intellectual disabilities by obtaining the perspective of their parents. A questionnaire was used to collect the viewpoints of parents with adult children who have an intellectual disability in sports facilities. This questionnaire aimed to gather responses in relation to close-ended questions based on three dimensions: the reasons for participating in sports; general expectations of the sporting activities; and the effects of exercise in relation to adults with intellectual disabilities. The questionnaire was given to a sample set of 400 parents. 120 of these parents responded to and returned the questionnaire addressing the objectives of the study. The findings revealed that there are significant barriers that prevent people with intellectual disabilities from playing sports-including lack of training programs, the absence of their rights, and the difficulties of accessing sports facilities.

Initial validation of the Italian version of the Volition in Exercise Questionnaire (VEQ-I)

The purpose of this study was to validate the Volition in Exercise Questionnaire in Italian language (VEQ-I). The translation and cultural adaptation of the VEQ-I was conducted using the forward-backward translation method. VEQ-I eighteen items correspond to the six-factors structure of the original version. The construct validity was verified by the confirmatory factor analysis (CFA) (CFI = 0.960; TLI = 0.943; RMSEA = 0.039; and SRMR = 0.040). The eighteen items were well distributed in six subscales and the six-factors structure of the questionnaire was supported. Internal Consistency value of the questionnaire was investigated for each subscale of the VEQ-I. Cronbach’s alpha and Omega values of the Reasons, Postponing Training, Unrelated Thoughts, Self-Confidence, Approval from Others and Coping with Failure subscales were 0.76 (α) and 0.76 (ω), 0.76 (α) and 0.76 (ω), 0.87 (α) and 0.88 (ω), 0.85 (α) and 0.85 (ω), 0.70 (α) and 0.72 (ω) and 0.74 (α) and 0.74 (ω), respectively. They were acceptable in all the six subscales. The concurrent validity was assessed using the correlation among the subscales of VEQ-I measures and those contained in two questionnaires: Psychobiosocial States in Physical Education (PBS-SPE) and Exercise Motivations Inventory (EMI-2).

Active Time in Cooperative Activities, Quality of Life and Body Mass Index in Individuals with Intellectual Disabilities. A Model of Structural Equations

Current research shows that individuals with intellectual disabilities do not engage in enough physical activity to acquire health benefits. However, cooperative learning has been shown to be an effective tool for inclusion and for improving healthy physical habits. The aim of this study is to contrast an explanatory model which incorporates quality of life, active time in cooperative activities, body mass index and age, as well as to analyze, using multi-group structural equations, the existing associations according to the sex of subjects with intellectual disabilities. The convenience sampling used allowed the collection of data from a total of 156 subjects in Granada (Spain), aged between 18–55 years. In terms of gender, the sample was homogeneous, representing 52.6% (n = 82) for women and 47.4% (n = 74) for men. The active time during the cooperative learning was recorded with the Xiaomi Mi Band 2 activity band, for the quality of life scale (GENCAT) was used, and the body mass index was calculated through its standardized equation. Age was directly associated with body mass index in both sexes. Likewise, age was positively related to the active time of women. Quality of life was directly associated with active time and body mass index was inversely related to active time. This study shows the importance of active time during work and cooperative learning in individuals with intellectual disabilities, as it is associated with an improvement in the quality of life and a reduction in the problems of sedentarism, overweight, and obesity.

Intellectual disability, exercise and aging: the IDEA study: study protocol for a randomized controlled trial

BACKGROUND

People with intellectual disabilities (ID) have low levels of physical activity (PA) together with accelerated aging profiles. Adherence to PA interventions for persons with ID is low based on barriers such as motivation. The IDEA study aims to determine the effect of two types of exercise programs, continuous aerobic (CAEP) vs sprint interval training (SIT), designed for seniors with ID on health-related physical fitness, cardiovascular parameters, quality of life (QoL), and emotional and cognitive function.

METHODS

In this trial, ninety seniors with ID between the ages of 40 and 75 yrs. from occupational health centers from the Autonomous Region of Catalonia (Spain) will be recruited. Participants will be randomly allocated to the CAEP, SIT, and control group. Both intervention groups will train 3 days/week, 1.5 h/day over 6 months. Outcome variables will be assessed at baseline, 6 months and 12 months. The outcome variables include weight, height, body composition, cardiorespiratory fitness, muscle strength, balance, flexibility, cardiovascular parameters (blood pressure, pulse-wave velocity, pulse-wave analysis), QoL and cognitive function. The intervention effect will be determined with mixed models with repeated measures to assess changes in the outcome variables over time (baseline to month 12) and between study arms. Relationship between variables will be analyzed with appropriate regression analyses.

DISCUSSION

Various studies reported on CAEP and SIT as exercise interventions for persons with ID with beneficial outcomes on body composition, fitness and blood pressure. To our knowledge, this is the first trial designed to analyse the positive changes on fitness, PA levels, cardiovascular, QoL and cognitive function promoted by CAEP training and SIT in seniors with ID. The findings of this study will assist in the development of more effective exercise interventions to ensure better compliance and adherence to exercise in seniors with ID.

TRIAL REGISTRATION

The trial is registered at the ISRCTN registry. Registration number: ISRCTN43594228 . Registered 11 February 2019 - Retrospectively registered.