Understanding capabilities, opportunities and motivations to engage in physical activity for adults with intellectual disabilities: A qualitative evidence synthesis.

BACKGROUND: There is a paucity of theory-informed physical activity research with adults with intellectual disabilities. This study aimed to address this by synthesising existing literature and applying the COM-B model to understand capabilities, opportunities and motivations. METHODS: A qualitative evidence synthesis was conducted and reported in accordance with PRISMA guidelines and the ENTREQ. Three databases were systematically searched up to and including February 2022. Qualitative research relating to the physical activity of adults with intellectual disabilities were included. Thematic synthesis was conducted with themes mapped onto the COM-B model. RESULTS: Twenty-five studies were included. Influences of physical activity were identified and mapped onto the COM-B model, which also included COM-B influences of social support provided by caregivers. CONCLUSIONS: There are many complex influences of physical activity for adults with intellectual disabilities. Researchers should consider the influences contributing to caregivers' capacity to support physical activity.

Associations between motor competence and physical activity levels of children with intellectual disabilities and/or autism spectrum disorder: Movement matters.

Motor competence is important for lifelong physical activity (PA). The current study aimed to examine associations between PA and motor competence. In total, 43 children aged 7-12 years with intellectual disabilities and/or autism spectrum disorder completed anthropometric measures, the Bruininks-Oseretsky Test of Motor Proficiency-2, and wore a wrist accelerometer to capture total PA, moderate-to-vigorous PA (MVPA), average acceleration, and intensity gradient. No significant associations were found between PA outcomes and motor competence. Motor competence performance was commonly 'below average' or 'average'. The weakest subtests were upper limb coordination and strength. The strongest subtest was running speed and agility. Total weekly MVPA was 336.1 ± 150.3 min, higher than UK recommendations of 120-180 per week for disabled children and young people. Larger scale studies are needed to better understand the relationship between PA and motor competence. Future research should also consider the influence of environmental factors on PA in this group.

Exploring parents' experiences of promoting physical activity for their child with intellectual disabilities.

INTRODUCTION: Children and adolescents with intellectual disabilities participate in low levels of physical activity and have a greater reliance on their parents to provide activity opportunities. This study explored parents' experiences of promoting physical activity for their child with intellectual disabilities. METHODS: Semi-structured interviews were conducted with eight parents of children and adolescents with intellectual disabilities. Interviews were independently coded and analysed by two researchers using thematic analysis. RESULTS: Four themes and nine subthemes were identified. Overall, parents had positive views of physical activity. However, parents face numerous barriers that limit their ability to promote physical activity for their child with intellectual disabilities. CONCLUSIONS: Parents experience high levels of exclusion and stigma that negatively affect their promotion of physical activity for their child with intellectual disabilities. Overcoming the barriers faced by parents could therefore be an indirect method to increase physical activity in children and adolescents with intellectual disabilities.

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

BACKGROUND: Adults with intellectual disabilities are reported to be highly inactive, with research required to understand contributory factors. This systematic review aimed to investigate gender differences in physical activity (PA) and sedentary behaviour (SB) in adults with intellectual disabilities. METHODS: This systematic review was reported in accordance with PRISMA guidelines. Seven databases were searched up to, and including, January 2018. Screening identified papers that assessed gender-specific PA and/or SB outcomes in adults with intellectual disabilities. Data were synthesized using a narrative synthesis and random effects model meta-analyses. RESULTS: Twenty-six papers were included; 25 measured PA, and eight assessed SB. Women with intellectual disabilities were least active with a significant overall effect of gender identified. For SB, no consistent gender differences were found. CONCLUSIONS: Reflecting the general population, men with intellectual disabilities were most active. Intellectual disability research should consider the role of gender to inform future interventions targeting inactivity.

Patterns of objectively measured sedentary behaviour in adults with intellectual disabilities.

BACKGROUND: The purpose of this study was to investigate the patterns of objectively measured sedentary behaviour in adults with intellectual disabilities. METHODS: Baseline accelerometer data were pooled from two randomized controlled trials of lifestyle behaviour change programmes for adults with intellectual disabilities. Patterns of sedentary behaviours were computed including total volume, number, and duration of bouts and breaks. RESULTS: Participants spent >70% of the day sedentary (8 hr), which was generally accumulated in short sedentary bouts (<10 min). Participants were engaged in significantly more sedentary time during the morning, although differences between time of day were small (mean bout duration range: 19.8-22.3 min). CONCLUSIONS: The findings add valuable insight into the patterns of sedentary behaviours among adults with intellectual disabilities. Further research investigating the patterns and context of sedentary behaviour is required to develop targeted interventions to reduce total sedentary time in adults with intellectual disabilities.

Parental perceptions of facilitators and barriers to physical activity for children with intellectual disabilities: A mixed methods systematic review.

BACKGROUND: There is a need increase our understanding of what factors affect physical activity participation in children with intellectual disabilities (ID) and develop effective methods to overcome barriers and increase activity levels. AIM: This study aimed to systematically review parental perceptions of facilitators and barriers to physical activity for children with ID. METHODS: A systematic search of Embase, Medline, ERIC, Web of Science, and PsycINFO was conducted (up to and including August, 2017) to identify relevant papers. A meta-ethnography approach was used to synthesise qualitative and quantitative results through the generation of third-order themes and a theoretical model. RESULTS: Ten studies were included, which ranged from weak to strong quality. Seventy-one second-order themes and 12 quantitative results were extracted. Five third-order themes were developed: family, child factors, inclusive programmes and facilities, social motivation, and child's experiences of physical activity. It is theorised that these factors can be facilitators or barriers to physical activity, depending on the information and education of relevant others, e.g. parents and coaches. CONCLUSIONS: Parents have an important role in supporting activity in children with ID. Increasing the information and education given to relevant others could be an important method of turning barriers into facilitators.

Correlates of objectively measured sedentary time in adults with intellectual disabilities.

Sedentary behaviour is an independent risk factor for adverse health conditions. Adults with intellectual disabilities spend a high proportion of their day engaged in sedentary behaviour, however, there is limited evidence on potential correlates of objectively measured sedentary behaviour in this population group. In Glasgow, UK from July to September 2017, a secondary analysis of pooled baseline accelerometer data from two randomised controlled trials of lifestyle behaviour change programmes was conducted. Backwards linear regression was used to investigate the associations between demographic, biological, and environmental correlates and objective measure of sedentary behaviour (percentage of time spent sedentary). One-hundred and forty-three participants provided valid accelerometer data. Mean percentage time spent sedentary (adjusted for wear time) was 72.9% [Standard Deviation (SD) = 8.7] per day. In the final model, physical and mental health problems were significantly (p < 0.05) associated with increased percentage time spent sedentary. This is the first study to provide evidence on multi-level, demographic, biological, and environmental correlates of objectively measured sedentary behaviour in adults with intellectual disabilities. To inform the development of interventions to modify sedentary behaviours in adults with intellectual disabilities, further research is required including a wide range of socio-ecological correlates.

Calibration and Cross-Validation of the ActiGraph wGT3X+ Accelerometer for the Estimation of Physical Activity Intensity in Children with Intellectual Disabilities.

BACKGROUND: Valid objective measurement is integral to increasing our understanding of physical activity and sedentary behaviours. However, no population-specific cut points have been calibrated for children with intellectual disabilities. Therefore, this study aimed to calibrate and cross-validate the first population-specific accelerometer intensity cut points for children with intellectual disabilities. METHODS: Fifty children with intellectual disabilities were randomly assigned to the calibration (n = 36; boys = 28, 9.53±1.08yrs) or cross-validation (n = 14; boys = 9, 9.57±1.16yrs) group. Participants completed a semi-structured school-based activity session, which included various activities ranging from sedentary to vigorous intensity. Direct observation (SOFIT tool) was used to calibrate the ActiGraph wGT3X+, which participants wore on the right hip. Receiver Operating Characteristic curve analyses determined the optimal cut points for sedentary, moderate, and vigorous intensity activity for the vertical axis and vector magnitude. Classification agreement was investigated using sensitivity, specificity, total agreement, and Cohen's kappa scores against the criterion measure of SOFIT. RESULTS: The optimal (AUC = .87-.94) vertical axis cut points (cpm) were ≤507 (sedentary), 1008-2300 (moderate), and ≥2301 (vigorous), which demonstrated high sensitivity (81-88%) and specificity (81-85%). The optimal (AUC = .86-.92) vector magnitude cut points (cpm) of ≤1863 (sedentary), 2610-4214 (moderate), and ≥4215 (vigorous) demonstrated comparable, albeit marginally lower, accuracy than the vertical axis cut points (sensitivity = 80-86%; specificity = 77-82%). Classification agreement ranged from moderate to almost perfect (κ = .51-.85) with high sensitivity and specificity, and confirmed the trend that accuracy increased with intensity, and vertical axis cut points provide higher classification agreement than vector magnitude cut points. CONCLUSIONS: This study provides the first valid methods of interpreting accelerometer output in children with intellectual disabilities. The calibrated physical activity cut points are notably higher than existing cut points, thus raising questions on the validity of previous low physical activity estimates in children with intellectual disabilities that were based on typically developing cut points.

Feasibility of a laboratory-based accelerometer calibration protocol for children with intellectual disabilities.

BACKGROUND: Accelerometry has not been calibrated for the estimation of physical activity in children with intellectual disabilities (ID), raising questions regarding the validity of interpreting accelerometer data in this population. Various protocols and criterion measures have been used in calibration studies involving typically developing (TD) children; however, the suitability of these activities and measures for children with ID is unknown. Therefore, this study aimed to test the feasibility of a laboratory-based calibration protocol for children with ID. Specifically, the feasibility of activities, measurements, and recruitment was investigated. METHODS: Five children with mild to moderate ID (10.20 ± .98 years) and a comparative sample of five TD children (12.40 ± .01 years) participated in this study. Participants performed a free-living and treadmill-based activity protocol during two laboratory-based sessions. Activities were performed for 5 min and ranged from sedentary to vigorous intensity. Treadmill activities ranged from 3 to 8 km/h, and free-living activities included watching a DVD, passing a football, and jumping jacks. Resting energy expenditure was measured, and a graded exercise test was used to assess cardiorespiratory fitness. Breath-by-breath respiratory gas exchange and accelerometry were continually measured during all activities. Feasibility was assessed using observations, activity completion rates, and respiratory data. RESULTS: All TD participants and one participant with ID completed the protocol. The physical demands of the treadmill activities affected the completion rate for participants with ID. No participant met the maximal criteria for the graded exercise test or attained a steady state during the resting measurements. Limitations were identified with the usability of respiratory gas exchange equipment and the validity of measurements. The school-based recruitment strategy was not effective, with a participation rate of 6 %. A significant (z = 13.21, p < .0001) difference in the relationship of [Formula: see text] and accelerometry was identified between ID and TD participants. CONCLUSIONS: Due to issues with the usability and validity of breath-by-breath respiratory gas exchange and recruitment, a laboratory-based calibration protocol is currently not feasible for children with ID. An alternative field-based protocol with a non-invasive criterion measure should be considered for future studies.

Accelerometer use during field-based physical activity research in children and adolescents with intellectual disabilities: a systematic review.

Many methodological questions and issues surround the use of accelerometers as a measure of physical activity during field-based research. To ensure overall research quality and the accuracy of results, methodological decisions should be based on study research questions. This paper aims to systematically review accelerometer use during field-based research in children and adolescents with intellectual disabilities. Medline, Embase, Cochrane Library, Web of Knowledge, PsycINFO, PubMed, and a thesis database (up to May 2013) were searched to identify relevant articles. Articles which used accelerometry-based monitors, quantified activity levels, and included ambulatory children and adolescents (≤ 18 years) with intellectual disabilities were included. Based on best practice guidelines, a form was developed to extract data based on 17 research components of accelerometer use. The search identified 429 articles. Ten full-text articles met the criteria and were included in the review. Many shortcomings in accelerometer use were identified, with the percentage of review criteria met ranging from 12% to 47%. Various methods of accelerometer use were reported, with most use decisions not based on population-specific research. However, a lack of measurement research, e.g., calibration/validation, for children and adolescents with intellectual disabilities is limiting the ability of field-based researchers to make to the most appropriate accelerometer use decisions. The methods of accelerometer use employed can have significant effects on the quality and validity of results produced, which researchers should be more aware of. To allow informed use decisions, there should be a greater focus on measurement research related to children and adolescents with intellectual disabilities.