Feasibility of a laboratory-based protocol for measuring energy expenditure and accelerometer calibration in adults with intellectual disabilities.

Adults with intellectual disabilities experience numerous health inequalities. Targeting unhealthy lifestyle behaviours, such as high levels of sedentary behaviour and overweight/obesity, is a priority area for improving the health and adults with intellectual disabilities and reducing inequalities. Energy expenditure is a fundamental component of numerous health behaviours and an essential component of various free-living behaviour measurements, e.g. accelerometry. However, little is known about energy expenditure in adults with intellectual disabilities and no population-specific accelerometer data interpretation methods have been calibrated. The limited research in this area suggests that adults with intellectual disabilities have a higher energy expenditure, which requires further exploration, and could have significant impacts of device calibration. However, due to the complex methods required for measuring energy expenditure, it is essential to first evaluate feasibility and develop an effective protocol. This study aims to test the feasibility of a laboratory-based protocol to enable the measurement of energy expenditure and accelerometer calibration in adults with intellectual disabilities.We aimed to recruit ten adults (≥ 18 years) with intellectual disabilities. The protocol involved a total of nine sedentary, stationary, and physical activities, e.g. sitting, lying down, standing, and treadmill walking. Each activity was for 5 min, with one 10 min lying down activity to measure resting energy expenditure. Breath by breath respiratory gas exchange and accelerometry (ActiGraph and ActivPAL) were measured during each activity. Feasibility was assessed descriptively using recruitment and outcome measurement completion rates, and participant/stakeholder feedback.Ten adults (N = 7 female) with intellectual disabilities participated in this study. The recruitment rate was 50% and 90% completed the protocol and all outcome measures. Therefore, the recruitment strategy and protocol are feasible.This study addresses a significant gap in our knowledge relating to exercise laboratory-based research for adults with intellectual disabilities The findings from this study provide essential data that can be used to inform the development of future protocols to measure energy expenditure and for accelerometer calibration in adults with intellectual disabilities.

Supporting active engagement of adults with intellectual disabilities in lifestyle modification interventions: a realist evidence synthesis of what works, for whom, in what context and why.

BACKGROUND: Lifestyle modification interventions for adults with intellectual disabilities have had, to date, mixed effectiveness. This study aimed to understand how lifestyle modification interventions for adults with intellectual disabilities work, for whom they work and in what circumstances. METHODS: A realist evidence synthesis was conducted that incorporated input from adults with intellectual disabilities and expert researchers. Following the development of an initial programme theory based on key literature and input from people with lived experience and academics working in this field, five major databases (MEDLINE, EMBASE, CINAHL, PsycINFO and ASSIA) and clinical trial repositories were systematically searched. Data from 79 studies were synthesised to develop context, mechanism and outcome configurations (CMOCs). RESULTS: The contexts and mechanisms identified related to the ability of adults with intellectual disabilities to actively take part in the intervention, which in turn contributes to what works, for whom and in what circumstances. The included CMOCs related to support involvement, negotiating the balance between autonomy and behaviour change, fostering social connectedness and fun, accessibility and suitability of intervention strategies and delivery and broader behavioural pathways to lifestyle change. It is also essential to work with people with lived experiences when developing and evaluating interventions. CONCLUSIONS: Future lifestyle interventions research should be participatory in nature, and accessible data collection methods should also be explored as a way of including people with severe and profound intellectual disabilities in research. More emphasis should be given to the broader benefits of lifestyle change, such as opportunities for social interaction and connectedness.

Individual, interpersonal and environmental correlates of sedentary behaviours in adults with intellectual disabilities.

BACKGROUND: Sedentary behaviours have adverse health outcomes and adults with intellectual disabilities are at a higher risk of unhealthy lifestyle behaviours. The lack of knowledge relating to sedentary behaviours in adults with intellectual disabilities has impeded the development of effective interventions. This study aimed to investigate individual, interpersonal and environmental correlates that are associated with sedentary behaviours in adults with intellectual disabilities. METHOD: A secondary analysis of data from The UK Household Longitudinal Study (Understanding Society; collected 2011-2013) was conducted. Twenty-two predictor variables were included in a stepwise logistic regression, with TV hours during weekdays (≤3 and >3 h/day) used as a proxy for sedentary behaviours. A sample of 266 adults, with mean age of 37.9 and range from 18 to 49 years old, with intellectual disabilities were identified. Because 63.9% were female, 62.4% had children and 28.2% were employed, the sample is likely to be most representative of more able adults with intellectual disabilities. RESULTS: A significant interaction term between having children and neighbourhood status was found in the initial model so separate models for good and poor-quality neighbourhoods are reported. Having children only had a significant effect to lower the odds of high TV time among participants living in good quality neighbourhoods (OR 0.10, 95% CI 0.03, 0.25). However, for people living in poor quality neighbourhoods it was better quality leisure services that was associated with lower odds of high TV time (OR 0.48, 95% CI 0.23, 0.90). Being employed only significantly reduced the odds of high TV time in the good quality neighbourhood model (OR 0.35, 95% CI 0.12, 0.78). These effects highlight the importance of environmental effects on lifestyle behaviours of adults with intellectual disabilities. CONCLUSIONS: Future research should aim to expand our understanding of environmental effects on the sedentary behaviours and other lifestyle behaviours of adults with intellectual disabilities.

Correlates of physical activity in children and adolescents with intellectual disabilities: a systematic review.

BACKGROUND: Children and adolescents with intellectual disabilities (ID) participate in low levels of physical activity. To inform the development of interventions, we need to better understand factors associated with physical activity. The aim of this study was therefore to systematically review correlates of physical activity in children and adolescents with ID. METHODS: The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Ovid MEDLINE, Ovid Embase, Web of Science, ERIC, CINAHL and PsycINFO were searched between 1 January 1990 and 29 February 2020 to identify English-language studies, which examined correlates of free-living physical activity in children and adolescents (0-19 years) with ID. Study quality was assessed. Correlates were analysed using a narrative synthesis and classified using the socioecological model as intrapersonal, interpersonal, organisational or environmental. RESULTS: Fifteen studies published between 2010 and 2019 met the inclusion criteria and were included in the review. Forty-eight individual correlates were identified. Studies were predominantly focused on intrapersonal-level correlates. Of those correlates investigated in more than one study (n = 6), having better motor development was positively associated with physical activity. Inconsistent results were found for age and cardiorespiratory fitness. Sex, percentage body fat and body mass index were not correlated. No interpersonal-level, organisational-level or environmental-level correlates were included in more than one study. CONCLUSIONS: To date, we have limited and inconclusive evidence about correlates of physical activity in children and adolescents with ID. Only when future studies unravel correlates and determinants, across all domains of the socioecological model, will the potential opportunities to improve health by increasing physical activity levels be achievable.

A systematic review and meta-analysis of interventions to increase physical activity in children and adolescents with intellectual disabilities.

BACKGROUND: Increasing physical activity (PA) through intervention can promote physical and mental health benefits in children and adolescents. However, children and adolescents with intellectual disabilities (ID) have consistently been shown to engage in low levels of PA, which are insufficient for long-term health. Despite this, little is known about the effectiveness of interventions to increase PA in children and adolescents with ID. The aims of this study were therefore to systematically review how effective interventions are at increasing PA levels in children and adolescents with ID and to further examine what components have been used in these interventions. METHOD: A systematic search of MEDLINE, EMBASE, Education Resources Information Center, Cumulative Index to Nursing and Allied Health Literature, PsychINFO, Cochrane Central Register for Controlled Trials and International Standard Randomised Controlled Trial Number trials registry was conducted (up to July 2016). Articles were included if they met the following eligibility criteria: children and adolescents (<18 years) with ID, measurement of PA at baseline and post-intervention and intervention studies. Effect sizes were calculated as standardised mean difference (d) and meta-analysis calculated between intervention and no treatment control intervention. RESULTS: Five studies met the eligibility criteria and were included in the review. Study design, methodological quality and intervention components were varied. Interventions did not support sufficient changes in PA to improve health. The meta-analysis demonstrated that intervention groups were not more effective at increasing PA levels post-intervention (d: 2.20; 95% CI -0.57 to 0.97) compared with control. However, due to a decrease in PA in the control intervention, a moderate significant effect was demonstrated at follow-up (d: 0.49; 95% CI 0.14 to 0.84). CONCLUSIONS: There is a lack of studies which aim to increase PA levels in children and adolescents with ID, with current interventions ineffective. Future studies are required before accurate recommendations for appropriate intervention design and components can be made.