Research Trends and Recommendations for Physical Activity Interventions Among Children and Youth With Disabilities: A Review of Reviews.

This scoping review synthesized reviews of physical activity (PA) interventions for children and youth with disabilities to highlight promising elements of effective interventions, research methodological limitations, and research priorities. Twenty studies were eligible and underwent three rounds of review by an expert panel. Rich and diverse PA programs derived potential short-term benefits toward health, function, and PA. Strategies to increase sample sizes included embedding programs in the community and using information communication technology to deliver exercise programs. Methodological limitations of interventions included a lack of generalizability, transferability, and scientific rigor. Three research priorities were identified: develop and report precision-based intervention strategies, identify strategies that promote both long-term and sustainable PA participation and outcomes, and develop scalable interventions and recruitment strategies. If addressed, these areas could enhance the impact of PA interventions for children and youth with disabilities.

Interventions to promote physical activity for youth with intellectual disabilities.

OBJECTIVE: To describe interventions designed to promote physical activity for youth with intellectual disabilities. MATERIALS AND METHODS: A systematic review of nine databases until January 31, 2015 identified 213 citations. The inclusion criteria were: a) the study sample consisted of youth with intellectual disabilities, b) the study implemented an intervention to initiate, increase, or maintain physical activity, and c) quantitative or qualitative data were used to report the effectiveness of the intervention. Eleven articles from the 213 citations met this criterion. RESULTS: Nine studies reported significant increases in physical activity behavior. CONCLUSIONS: Conclusions cannot be made regarding intervention components that impacted outcome variables, if the observed effects were specifically due to the intervention or if interventions could be maintained long-term. To advance the knowledge base in this area, a concerted effort should be made to increase rigor in study conceptualization and research design.

Interventions to promote physical activity for adults with intellectual disabilities.

OBJECTIVE: To describe interventions designed to promote physical activity for adults with intellectual disabilities and the effects on overall physical activity levels and on health outcomes. MATERIALS AND METHODS: A systematic review of eight databases until January 31, 2015 identified 383 citations. The inclusion criteria were: a) the study sample consisted of adults with intellectual disabilities, b) the study implemented an intervention to initiate, increase, or maintain physical activity, and c) quantitative or qualitative data were used to report the effectiveness of the intervention. Six articles from the 383 citations met this criterion. RESULTS: Three studies resulted in significant increases in physical activity behaviour; however well-controlled trials designed to improve weight status by increasing physical activity did not produce significant effects. CONCLUSION: Overall, the results indicate that interventions to increase physical activity should simultaneously target the individual with intellectual disability as well as their proximal environment over a sustained period of time.

Parents' Perspectives of Physical Activity in Their Adult Children With Autism Spectrum Disorder: A Social-Ecological Approach.

The purpose of this study was to investigate parent perceptions of the physical activity (PA) engagement of their adult children with autism spectrum disorders. The theoretical framework used in this study was social ecology. Participants were nine parents from families with one adult child with autism spectrum disorder whose ages ranged from 18 to 42. Using phenomenological interviews, which explored parents' life experience and meaning making, four themes were generated: supports and advocacy for PA, engaging in PA independently, benefits of PA, and barriers to or reasons for disengaging in particular activities. Parents' interview comments showed that intrapersonal factors, interpersonal relationships, and community factors were essential for keeping the individuals with autism spectrum disorder engaged in PA. Families and practitioners can take advantage of that by seeking PA opportunities in community settings or with other individuals.

Postural balance control interventions in autism spectrum disorder (ASD): A systematic review.

BACKGROUND: Postural control (PC) disturbances in autism spectrum disorder (ASD) are associated with its severity. Varied sensorimotor interventions have been used for the management of these symptoms. However, there is a lack of a review elucidating all the available postural control interventions in ASD. RESEARCH QUESTION: To comprehensively present the variety of interventions targeted at improving PC in ASD and to provide future research recommendations. METHODS: PubMed, SCOPUS, Embase, Cochrane, ScienceDirect and Web of Science databases were searched for publications examining the effects of PC targeting interventions in those with ASD. Included articles were in English, published after 2000 in the peer-reviewed journals with full text available and used intervention targeted at improving PC or balance with a predefined objective outcome measure for accessing PC or balance. Initial database search yielded 1022 studies and 21 articles were included in this review after screening. RESULTS: We identified diverse PC interventions including animal assisted therapies, karate/martial arts, aquatic exercises, virtual reality-based training, standard and customized exercises, and physical activity programs. The effect of long- and short-term interventions on PC improvement in children and adults with ASD is mixed. Future research should focus on undertaking randomized controlled trials with large sample size and participants with varying severity of ASD to improve generalizability of the study findings. The lack of population-specific, reliable, and validated motor outcome measures including neuro-imaging techniques should be addressed. SIGNIFICANCE: While many of the interventions improved PC in those with ASD, the sample size and methodological quality of the studies was highly variable. There are limited studies exploring the long-term effects of the interventions. Rigorous study methods with population-specific objective outcome measures are warranted to draw generalizable conclusions regarding the PC interventions in individuals with ASD.

Concordance Between Accelerometer-Measured and Self-Reported Physical Activity and Sedentary Time in Adults with Autism.

This study examined the concordance between accelerometry-measured and self-reported physical activity (PA) and sedentary time in adults with autism. Twenty-four participants wore an ActiGraph GT3X + accelerometer for seven consecutive days and completed the International Physical Activity Questionnaire-Short Form (IPAQ-SF) on the last day of their study participation. Bland-Altman plots assessed the magnitude of agreement between the two measures. Nearly 80% of the participants accumulated the recommended ≥ 150 min of moderate to vigorous PA (MVPA)/week, but were also sedentary for over nine hours/day according to accelerometry data. Findings showed that adults with autism tended to overreport MVPA (b = 1.606, p < 0.01) and underreport sedentary time (b = 1.161, p = 0.03) via the IPAQ-SF, as compared to objective measurements.

Correlates of moderate-to-vigorous physical activity participation in adults with intellectual disabilities.

Adults with intellectual disabilities (ID) have low levels of physical activity and higher than average rates of related chronic health conditions. Understanding correlates of their physical activity participation may improve health promoting interventions. Forty-two adults with ID participated in a physical activity study. Physical activity knowledge and skills, awareness of recommendations and demographic characteristics were analyzed for their association with moderate-to-vigorous physical activity (MVPA) participation measured by accelerometers. Five variables were significantly correlated with MVPA. Body mass index was inversely correlated with MVPA, and gender, job location, job tasks, and place of residence were all significantly associated with MVPA. Understanding correlates of physical activity in this population will help inform disability service and health promotion professionals in future research and health intervention design.

Developing a physical activity education curriculum for adults with intellectual disabilities.

Adults with intellectual disabilities have high rates of physical inactivity and related chronic diseases. Researchers have called for an increase in the development and evaluation of health education programs adapted to the unique needs of this population. Formative and process evaluation strategies were applied to develop a physical activity education program. The first phase of formative evaluation included a comprehensive literature review to select educational strategies and curriculum content. The theory of planned behavior was selected as a guiding framework, and meetings with stakeholders were held to assess feasibility. The second phase of formative evaluation included an assessment of materials by an expert panel and the priority population, and pilot testing. Next, field testing was implemented, followed by process evaluation and an assessment of implementation fidelity. The final curriculum was developed as a result of the completion of the aforementioned steps and led to a successful physical activity intervention.

Effects of a Gamified, Behavior Change Technique-Based Mobile App on Increasing Physical Activity and Reducing Anxiety in Adults With Autism Spectrum Disorder: Feasibility Randomized Controlled Trial.

BACKGROUND: Physical activity (PA) has an impact on physical and mental health in neurotypical populations, and addressing these variables may improve the prevalent burden of anxiety in adults with autism spectrum disorder (ASD). Gamified mobile apps using behavior change techniques present a promising way of increasing PA and reducing sedentary time, thus reducing anxiety in adults with ASD. OBJECTIVE: This study aimed to compare the effectiveness of a gamified and behavior change technique-based mobile app, PuzzleWalk, versus a commercially available app, Google Fit, on increasing PA and reducing sedentary time as an adjunct anxiety treatment for this population. METHODS: A total of 24 adults with ASD were assigned to either the PuzzleWalk or Google Fit group for 5 weeks using a covariate-adaptive randomization design. PA and anxiety were assessed over 7 days at 3 different data collection periods (ie, baseline, intervention start, and intervention end) using triaxial accelerometers and the Beck Anxiety Inventory. Group differences in outcome variables were assessed using repeated-measures analysis of covariance, adjusting for age, sex, and BMI. RESULTS: The findings indicated that the PuzzleWalk group spent a significantly longer amount of time on app use compared with the Google Fit group (F2,38=5.07; P=.01; partial η2=0.21), whereas anxiety was unfavorably associated with increases in light PA and decreases in sedentary time after intervention (all P<.05). CONCLUSIONS: Further research is needed to clarify the determinants of physical and mental health and their interrelationship in adults with ASD to identify the factors that facilitate the use and adoption of mobile health technologies in these individuals. Despite these mixed results, the small changes in PA or anxiety may be clinically significant for adults with ASD. TRIAL REGISTRATION: ClinicalTrials.gov NCT05466617; https://clinicaltrials.gov/show/NCT05466617.

Usability inquiry of a gamified behavior change app for increasing physical activity and reducing sedentary behavior in adults with and without autism spectrum disorder.

The purpose of this study was to conduct the first usability inquiry of a gamified, behavior change theory-guided mobile app PuzzleWalk for increasing physical activity and reducing sedentary behavior in adults with and without autism spectrum disorder (ASD). Eighteen adults with and without ASD participated in a mixed-methods study that consisted of cognitive walkthrough, system usability assessment, and qualitative interviews. The results of the system usability testing indicated satisfactory quality of the PuzzleWalk system that can be readily applicable to both adults with and without ASD. Several notable issues were identified from the qualitative interviews that address critical insights into unique health and social needs in adults with ASD. Future work is warranted to examine the long-term effects of the PuzzleWalk system on increasing physical activity and reducing sedentary behavior in adults with and without ASD in real-world settings.

PuzzleWalk: A theory-driven iterative design inquiry of a mobile game for promoting physical activity in adults with autism spectrum disorder.

Primary symptoms of adults with autism spectrum disorder (ASD), such as pervasive social deficits in social interaction and communication, cause adults with ASD to adopt a sedentary lifestyle. Meanwhile, gamified and behavioral theory-based interventions have been shown to improve physical activity in a fun and unobtrusive way. In this paper, we describe the iterative design inquiry process of PuzzleWalk, a gamified, physical activity-promoting mobile app designed for adults with ASD. We report the design rationales and lessons learned across four user-centered design phases with ASD experts and adults with ASD, including user requirement gathering, iterative participatory design, usability evaluation, and field deployment. The design insights generated from this work could inform future research focusing on designing sociotechnical systems, games, and interventions for people with ASD.

Correlation between physical activity and self-rated health status of non-elderly adults with disabilities.

OBJECTIVES: Physical activity participation is a promising pathway for reducing chronic disease risk and improving health outcomes of adults with disabilities. The objective of this study was to examine physical activity participation as a potential predictor of self-rated health status of a unique sub-population of non-elderly, non-assistive device using adults with disabilities. METHODS: This cross-sectional study analyzed population-based data from the 2007 U.S. Behavioral Risk Factor Surveillance System. A sample of 46,883 adults with disabilities was examined. Multivariable logistic regression analyses were conducted to determine whether physical activity participation predicted self-rated health status controlling for age, gender, income level, health insurance status, BMI, smoking status, education level, and heart disease, arthritis, asthma and diabetes diagnoses. RESULTS: Physical activity participation was significantly associated with self-rated health status. Those who participated in no physical activity were more likely to report fair or poor health by a factor of 3.3 (95% CI: 2.6-4.2) compared to those who met national recommendations for physical activity. Only 43.1% met one or both of the recommended physical activity guidelines. CONCLUSIONS: Adequate physical activity participation is correlated to better health status among adults with disabilities not associated with aging. Physical activity promotion is warranted for this population.

Health promotion for Latin Americans with intellectual disabilities.

In response to the emerging global concern regarding health and people with intellectual disabilities (ID), several developed countries have established national initiatives to address the unique health needs of this population segment. However, most people with ID reside in countries with developing economies, such as many Latin American countries, yet there is virtually no information on the health of people with ID in these regions. Countries with developing economies face distinct challenges in promoting health among this population segment that may preclude adoption or adaptation of policies and practices developed in regions with established economies. This paper will address the issue of health promotion among people with ID in Latin America, an area that is undergoing significant reforms in both health care and disability rights. Information on the social and health status of Latin Americans with ID, as well as research on health promotion best practices, will be used to develop recommendations for promoting health for these individuals.

Promotion of physical activity in individuals with intellectual disability.

This paper provides an overview of strategies that have been used to promote physical activity in individuals with intellectual disability. Several different approaches are discussed and the strengths and limitations of each are presented. Some determinants of physical activity for individuals with intellectual disability are also reported in an effort to better understand the factors that influence participation that could be targeted in future interventions. Recommendations for programming are provided.

Predicting transitory mood from physical activity level among people with severe mental illness in two cultures.

BACKGROUND: Previous studies have indicated that physical activity (PA) is positively related to health-related quality of life and well-being among people with severe mental illness (SMI). Physical activity is broadly defined in this research as any skeletal muscle movement resulting in energy expenditure, including common daily activities such as housework and gardening, as well as walking for transportation and formal exercise. Although the physical health benefits of PA are well documented, evidence suggests that PA provides psychological benefits as well. AIMS: The purpose of this study was to identify if PA level was associated with transitory mood in the everyday lives of people with SMI across two cultures. METHODS: Subjects were drawn through mental health centres in Serbia (n = 12) and the USA (n = 11). Data were collected using both experience sampling methodology and accelerometry. Data were analyzed using hierarchical linear modelling. RESULTS: Subjects demonstrated low levels of PA, which did not differ significantly between groups. Hierarchical analysis indicated that PA remained significantly positively associated with mood after accounting for individual variation, and this was consistent across groups. CONCLUSIONS: This study reinforces previous findings that people with SMI demonstrate low PA levels generally. It also supports the consideration of physical activity interventions as a regular part of psychiatric rehabilitation. It appears that increased PA may have the potential to affect both physical health and mood among people with SMI.

Physical Wellness Among Gaming Adults: Cross-Sectional Study.

BACKGROUND: Video and hobby gaming are immensely popular among adults; however, associations between gaming and health have primarily been investigated in children and adolescents. Furthermore, most research has focused on electronic gaming, despite traditional hobby gaming gaining prominence. OBJECTIVE: To determine whether the number of platforms used, platform preference, and gaming time are associated with obesity, physical activity, sedentary behavior, and cardiovascular risk factors in an adult gaming population. METHODS: We conducted a cross-sectional analysis using data obtained from 292 participants who attended a large Midwestern gaming convention. We collected data using a computer-based questionnaire that comprised questions on gaming behavior, demographics, physical activity (using the International Physical Activity Questionnaire), and health characteristics. In addition, we used multivariable-adjusted linear and logistic regression to model health outcomes as a function of the number of platforms used, platform preference, and weekday and weekend gaming time quartile. RESULTS: After adjusting for covariates, we observed a significant linear trend for increasing odds of being obese and higher weekend sitting time by the number of platforms used (P=.03 for both). The platform preference and weekend gaming time quartile exhibited significant associations with odds of meeting physical activity recommendations (P=.047 and P=.03, respectively). In addition, we observed higher odds of being obese among those reporting that they sat most or all of the time while gaming [odds ratio (OR) 2.69 (95% CI 1.14-6.31) and OR 2.71 (95% CI 1.06-6.93), respectively]. CONCLUSIONS: In adult gamers, the number of platforms used, which platforms they prefer to play on, and the amount of time spent gaming on weekends could have significant implications for their odds of being obese and meeting physical activity recommendations.

Physical activity patterns in youth with autism spectrum disorders.

The purpose of this study was to examine age-related physical activity patterns in youth with autism spectrum disorders (ASD). Thirty youth, aged 10-19 years, were divided into three groups: elementary (n=9), middle (n=9) and high (n=12) school. Participants wore an accelerometer and completed an activity questionnaire for seven consecutive days. The main findings were that (a) elementary youth are more active than the other groups, regardless type of day or time period, and (b) there are no consistent patterns in physical activity of youth with ASD according to day or time period. Findings emphasize that interventions for this population should address increasing extracurricular physical activity options during adolescence.

Physical activity of adults with mental retardation: review and research needs.

OBJECTIVE: To characterize physical activity levels of adults with mental retardation and identify limitations in published research. DATA SOURCES: Key word searches for "mental retardation," "intellectual disability," "learning disability," or "developmental disability" combined with "physical activity" or "habitual exercise" identified articles from MEDLINE, Academic Search Elite, Psych Articles, Health Source, and SPORT Discus. This produced a total of 801 citations. STUDY INCLUSION AND EXCLUSION CRITERIA: Published English-language literature that quantitatively measured physical activity levels of adults with mental retardation was included in this review. Fourteen articles met this criterion. DATA EXTRACTION: Characteristics of participants, study design, outcome measures, methods of analyses, and findings in terms of percentages, step counts, and accelerometer output were extracted. DATA SYNTHESIS: Data were synthesized to identify the percentage of adults with mental retardation who met published health-related physical activity criteria and compare them with adults without mental retardation and to examine study limitations. RESULTS: The studies with the greatest rigor indicate that one-third of adults or fewer with mental retardation were sufficiently active to achieve health benefits. However, data are insufficient to determine whether adults with mental retardation are less active than the general community. CONCLUSIONS: Future research would be enhanced by including appropriately powered representative samples, by including comparison groups, by validating physical activity questionnaires, and by determining the accuracy of proxy respondents.

Obesity in children with developmental and/or physical disabilities.

Children with developmental or physical disabilities, many of whom face serious health-related conditions, also are affected by the current obesity crisis. Although evidence indicates that children with disabilities have a higher prevalence of obesity than do children without disabilities, little is known of the actual magnitude of the problem in this population. To address this concern, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) held a conference on obesity in children with intellectual, developmental, or physical disabilities, bringing together scientists and practitioners in the fields of obesity and disability to foster collaboration, identify barriers to healthy weight status in populations with disabilities, propose avenues to solutions through research and practice, and develop a research agenda to address the problem. This article describes current knowledge about prevalence of obesity in this population, discusses factors influencing obesity risk, and summarizes recommendations for research presented at the conference.

Interventions to promote physical activity for adults with intellectual disabilities / Intervenciones para promover la actividad física para adultos con discapacidad intelectual

Abstract: Objective: To describe interventions designed to promote physical activity for adults with intellectual disabilities and the effects on overall physical activity levels and on health outcomes. Materials and methods: A systematic review of eight databases until January 31, 2015 identified 383 citations. The inclusion criteria were: a) the study sample consisted of adults with intellectual disabilities, b) the study implemented an intervention to initiate, increase, or maintain physical activity, and c) quantitative or qualitative data were used to report the effectiveness of the intervention. Six articles from the 383 citations met this criterion. Results: Three studies resulted in significant increases in physical activity behaviour; however well-controlled trials designed to improve weight status by increasing physical activity did not produce significant effects. Conclusion: Overall, the results indicate that interventions to increase physical activity should simultaneously target the individual with intellectual disability as well as their proximal environment over a sustained period of time.

Resumen: Objetivo: Describir las intervenciones diseñadas para promover la actividad física para adultos con discapacidad intelectual y los efectos en los niveles de actividad física en general y en los resultados de salud. Material y métodos: Una revisión sistemática de ocho bases de datos hasta el 31 de enero de 2015 identificó 383 citas. Los criterios de inclusión fueron: a) los participantes del estudio fueron adultos con discapacidad intelectual; b) el estudio implementó una intervención para iniciar, aumentar o mantener la actividad física; c) se usaron datos cuantitativos o cualitativos para informar la efectividad de la intervención. Seis artículos de 383 cumplieron con los criterios. Resultados: Tres estudios resultaron en aumentos significativos en conductas de actividad física; sin embargo, los ensayos controlados diseñados para mejorar el peso corporal al aumentar la actividad física no produjeron efectos significativos. Conclusión: En general, los resultados indican que las intervenciones para aumentar la actividad física deben dirigirse simultáneamente al individuo con discapacidad intelectual, así como su entorno próximo durante un periodo de tiempo sostenido.