Effecting healthy lifestyle changes in overweight and obese young adults with intellectual disability. Walk well: a randomised controlled trial of a walking intervention for adults with intellectual disabilities: study protocol Piloting a manualised weight management programme (Shape Up-LD) for overweight and obese persons with mild-moderate learning disabilities: study protocol for a pilot randomised controlled trial Promoting a healthy diet and physical activity in adults with intellectual disabilities living in community residences: Design and evaluation of a cluster-randomized intervention Effectiveness of a walking programme to support adults with intellectual disabilities to increase physical activity: walk well cluster-randomised controlled trial A structured physical activity and fitness programme for older adults with intellectual disabilities: results of a cluster‐randomised clinical trial An efficacy trial of ‘Steps to Your Health’, a health promotion programme for adults with intellectual disability Gait performance in dementia: the effects of a 6-week resistance training program in an adult day-care setting. A multi-component universal intervention to improve diet and physical activity among adults with intellectual disabilities in community residences: a cluster randomised controlled trial. Reliability of the PEDro scale for rating quality of randomized controlled trials. PEDro. A database of randomized trials and systematic reviews in physiotherapy. Attitudinal and psychosocial outcomes of a fitness and health education program on adults with down syndrome. Physical Activity Benefits of Learning to Ride a Two-Wheel Bicycle for Children With Down Syndrome: A Randomized Trial
We evaluated a 12-week recreation center-based healthy lifestyle intervention for 30 obese home-dwelling young adults ( YA ) with intellectual disabilities . Three cohorts participated : YA only , YA and parents , and parents only . The YA cohorts received a nutrition/exercise intervention ; parents focused on modeling healthy lifestyle behaviors . Outcomes included YA blood , nutrition , anthropometric , and fitness measures at pre , post , and 3-month follow-up . Compared with wait-list controls , the YA-only cohort improved immediately postintervention in blood pressure ( BP ) , weight , and balance ( p < .05 ) . At 3-month follow-up , no intervention was consistently superior ; overall reductions in weight , BP , hip circumference , and exercise barriers were obtained ( p < .05 ) . Linear and curvilinear changes from baseline to 3 months after the intervention varied by outcome and participant . Participants with Down syndrome lost less weight Background Walking interventions have been shown to have a positive impact on physical activity ( PA ) levels , health and wellbeing for adult and older adult population s. There has been very little work carried out to explore the effectiveness of walking interventions for adults with intellectual disabilities . This paper will provide details of the Walk Well intervention , design ed for adults with intellectual disabilities , and a r and omised controlled trial ( RCT ) to test its effectiveness . Methods / design This study will adopt a RCT design , with participants allocated to the walking intervention group or a waiting list control group . The intervention consists of three PA consultations ( baseline , six weeks and 12 weeks ) and an individualised 12 week walking programme . A range of measures will be completed by participants at baseline , post intervention ( three months from baseline ) and at follow up ( three months post intervention and six months from baseline ) . All outcome measures will be collected by a research er who will be blinded to the study groups . The primary outcome will be steps walked per day , measured using accelerometers . Secondary outcome measures will include time spent in PA per day ( across various intensity levels ) , time spent in sedentary behaviour per day , quality of life , self-efficacy and anthropometric measures to monitor weight change . Discussion Since there are currently no published RCTs of walking interventions for adults with intellectual disabilities , this RCT will examine if a walking intervention can successfully increase PA , health and wellbeing of adults with intellectual disabilities . Trial registration IS RCT N : IS RCT Background National obesity rates have dramatically risen over the last decade . Being obese significantly reduces life expectancy , increases the risk of a range of diseases , and compromises quality of life . Costs to both the National Health Service and society are high . An increased prevalence of obesity in people with learning disabilities has been demonstrated . The consequences of obesity are particularly relevant to people with learning disabilities who are already confronted by health and social inequalities . In order to provide healthcare for all , and ensure e quality of treatment for people with learning disabilities , services must be developed specifically with this population in mind . The aim of this project is to pilot the evaluation of a manualised weight management programme for  overweight and obese persons with mild-moderate learning disabilities ( Shape Up-LD ) . Methods / Design An individually r and omised , controlled pilot trial in 60 overweight and obese ( body mass index ≥ 25 ) adults ( age ≥ 18 ) with mild-moderate learning disabilities and their carers will be carried out , comparing “ Shape Up-LD ” with usual care . The manualised Shape Up-LD intervention will involve 12 weekly sessions , which include healthy eating messages , advice on physical activity and use of behaviour change techniques to help people manage their weight . Assessment s of participants will be conducted at baseline , 12 weeks and 6 months . Service users and their carers and service providers will also give their perspectives on the experience of Shape Up-LD in qualitative interviews at 12 weeks . Feasibility outcomes will include recruitment rates , loss to follow-up , compliance rates , completion rates , collection of information for a cost-effectiveness analysis and an estimation of the treatment effect on weight . Discussion The findings from this study will inform our preparation for a definitive r and omised controlled trial to test the efficacy of the programme with respect to weight loss and maintenance in this population . Weight loss through Shape Up-LD could lead to improvements in health and quality of life . Costs to the National Health Service might be reduced through decreased overall service use because of improved health . The programme would also ensure a more equitable service for overweight service users with learning disabilities and fill the current gap in weight management services for this population .Trial registration International St and ard R and omised Controlled Trial No IS RCT Background Many adults with intellectual disabilities have poor dietary habits , low physical activity and weight disturbances . This study protocol describes the design and evaluation of a health intervention aim ing to improve diet and physical activity in this target group . In Sweden , adults with intellectual disabilities often live in community residences where the staff has insufficient education regarding the special health needs of residents . No published lifestyle interventions have simultaneously targeted both residents and staff . Methods / Design The intervention is design ed to suit the ordinary work routines of community residences . It is based on social cognitive theory and takes 12 - 15 months to complete . The intervention includes three components : 1 ) Ten health education sessions for residents in their homes ; 2 ) the appointment of a health ambassador among the staff in each residence and formation of a network ; and 3 ) a study circle for staff in each residence . The intervention is implemented by consultation with managers , training of health educators , and coaching of health ambassadors . Fidelity is assessed based on the participation of residents and staff in the intervention activities . The study design is a cluster-r and omised trial with physical activity as primary outcome objective ly assessed by pedometry . Secondary outcomes are dietary quality assessed by digital photography , measured weight , height and waist circumference , and quality of life assessed by a quality of life scale . Intermediate outcomes are changes in work routines in the residences assessed by a question naire to managers . Adults with mild to moderate intellectual disabilities living in community residences in Stockholm County are eligible for inclusion .  Multilevel analysis is used to evaluate effects on primary and secondary outcomes . The impact of the intervention on work routines in community residences is analysed by ordinal regression analysis . Barriers and facilitators of implementation are identified in an explorative qualitative study through observations and semi-structured interviews . Discussion Despite several challenges it is our hope that the results from this intervention will lead to new and improved health promotion programs to the benefit of the target group . Trial registration numberIS RCT Background Programs to change health behaviours have been identified as one way to reduce health inequalities experienced by disadvantaged groups . The objective of this study was to examine the effectiveness of a behaviour change programme to increase walking and reduce sedentary behaviour of adults with intellectual disabilities . Methods We used a cluster r and omised controlled design and recruited participants over 18 years old and not regularly involved in physical activity from intellectual disabilities community-based organisations . Assessment s were carried out blind to allocation . Clusters of participants were r and omly allocated to the Walk Well program or a 12-week waiting list control . Walk Well consisted of three face-to-face physical activity consultations incorporating behaviour change techniques , written re sources for participants and carers , and an individualised , structured walking programme . The primary outcome measured with accelerometers was change in mean step count per day between baseline and 12 weeks . Secondary outcomes included percentage time per day sedentary and in moderate-vigorous physical activity ( MVPA ) , body mass index ( BMI ) , and subjective well being . Results One hundred two participants in 50 clusters were r and omised . 82 ( 80.4 % ) participants completed the primary outcome . 66.7 % of participants lived in the most deprived quintile on the Scottish Index of Multiple Deprivation . At baseline , participants walked 4780 ( st and ard deviation 2432 ) steps per day , spent 65.5 % ( st and ard deviation 10.9 ) of time sedentary and 59 % percent had a body mass in the obesity range . After the walking programme , the difference between mean counts of the Walk Well and control group was 69.5 steps per day [ 95 % confidence interval ( CI ) -1054 to 1193.3 ] . There were no significant between group differences in percentage time sedentary 1.6 % ( 95 % CI −2.984 to 6.102 ) , percentage time in MVPA 0.3 % ( 95 % CI −0.7 to 1.3 ) , BMI −0.2 kg/m2 ( 95 % CI −0.8 to 0.4 ) or subjective well-being 0.3 ( 95 % CI −0.9 to 1.5 ) . Conclusions This is the first published trial of a walking program for adults with intellectual disabilities . Positively changing physical activity and sedentary behaviours may require more intensive programmes or upstream approaches to address the multiple social disadvantages experienced by adults with intellectual disabilities . Since participants spent the majority of their time sedentary , home-based programmes to reduce sitting time may be a viable health improvement approach . Trial registration Current Controlled Trials IS RCT BACKGROUND The physical activity level of older adults with intellectual disabilities ( ID ) is extremely low , and their fitness levels are far beneath accepted norms for older people with normal intelligence and comparable with frail older people . A physical activity programme , including an education programme , was developed for older adults with ID using behaviour change techniques . The programme aim ed at improving or maintaining adequate levels of physical activity ( primary outcome measure ) and motor fitness , cardio respiratory fitness , morphologic and metabolic fitness , activities of daily living , cognitive functioning and depressive symptoms ( secondary outcome measures ) . METHOD The programme 's efficacy was evaluated in a cluster-r and omised clinical trial among people aged 43 years and over with mild-moderate levels of ID . Five day-activity centres were r and omised to the participation group . In these centres , 81 older adults participated in groups of 8 to 10 in the programme , three times a week during 8 months . The programme was executed by physical activity instructors and staff of day-activity centres . Five other day-activity centres were r and omised to the control group ; 70 older adults in these centres received care as usual . The generalised linear model with mixed effects was used to test the programme 's effectiveness . RESULTS Significant effects were found on physical activity , muscle strength , systolic and diastolic blood pressure , serum cholesterol level and cognitive functioning , in favour of the programme 's participants . No significant improvements were found on balance , serum glucose , weight , waist circumference , walking speed , mobility , depression or instrumental activities of daily living . CONCLUSIONS The physical activity and fitness programme has established small but significant effects in this sample , but generalising the findings to other setting s is difficult due to significant participant dropout . Implementation of evidence -based physical activity programmes among older adults with ID is recommended . Further research is needed to investigate the effectiveness of physical activity on daily life functioning and the development on chronic diseases in the long run Objective : Although there are evaluation and effectiveness studies of health promotion interventions for adults with intellectual disabilities ( ID ) , r and omized efficacy trials of such interventions are lacking . Design : A r and omized active control intervention trial . Setting : The participants attended the health promotion classes in local disability agency service facilities . Method : We enrolled 443 individuals and r and omly assigned them to one of two eight-week participatory classes . The ‘ Steps to Your Health ’ ( STYH ) classes emphasized moderate to vigorous physical activity ( MVPA ) , healthy eating and  body mass index ( BMI )  reduction . The control intervention focused on hygiene and safety . Results : We did not find a statistically significant difference in mean MVPA or BMI change between completers of the STYH group compared to the control group one year after the intervention was completed . We did find that participation in STYH classes had a non-significant association with odds of reduction in BMI ( odds ratio [ OR ] 2.87 , 95 % confidence interval [ CI ] 0.91–9.11 ) and completers who lived in group homes were more likely than their counterparts who lived with families or in apartments to decrease their BMI ( OR 4.61 ; 95 % CI 1.14–18.64 ) . Conclusions : This trial did not demonstrate a significant effect of STYH participation on change in mean minutes of MVPA or mean BMI 12 months after classes ended , although there was a non-significant association with odds of reduction of BMI ( p = 0.07 ) . This study has implication s for design of intervention studies in people with intellectual disability ( ID ) BACKGROUND Age-related declines in balance and muscle power are largely responsible for the changes in the various components of gait performance among elderly people . But these can often be remedied with strength training .  People with cognitive impairment frequently demonstrate impaired gait , putting them at increased risks for falls and serious injury . OBJECTIVES This paper reports on the effects of a six-week pilot study of moderate intensity strength training on the gait of elderly individuals with dementia who attend a day-care center . METHODS Twenty-six adults ( 23 female , three male ) , age = 79.2 + /- 6.6 years , completed the study . Each subject completed a baseline assessment of lower extremity strength and gait . Gait was evaluated using free- and fast-gait speed over a 6-meter course , the Tinetti-Gait Assessment scale , the ' Timed-Up- and -Go ' , and the Gait Assessment Rating Scale ( GARS ) . The intervention consisted of moderate-intensity progressive resistance lower extremity exercise using Therab and , for two to three sessions per week over the six weeks . Post-intervention assessment of strength and gait was repeated at the completion of the sixth week . Multiple paired t-tests were calculated for each outcome measure . RESULTS The baseline assessment of gait suggests a high degree of frailty and risk for falls in the sample . Although post-intervention scores reflected improvement on all gait measures , the only statistically significant change observed was in fast-gait time . CONCLUSION A six-week resistance training program proved to be of insufficient duration , intensity or specificity to produce significant change in gait outcome measures , with the exception of fast speed gait People with ID have an increased risk for unhealthy diets , physical inactivity and weight disturbances . The aim of the current study was to investigate the effectiveness of a novel and complex intervention to improve diet and physical activity , targeting both caregivers and residents , in community residences for people with ID . A three component intervention based on Social Cognitive Theory was developed , including : ( 1 ) appointment of a health ambassador in each community residence attending network meetings , ( 2 ) a study circle for caregivers , and ( 3 ) a health course for the residents . The intervention lasted for 12 - 16 months and allowed for some local tailoring . A cluster r and omised controlled trial , r and omised at residence level , was conducted to evaluate the effects of the intervention . Thirty community residences for people with mild or moderate ID in Stockholm County , Sweden , were included . A total of 130 participants , 74 women and 56 men aged 20 - 66 years , entered , and 129 participants completed the study . The primary outcome was physical activity , measured by pedometry . Secondary outcomes were BMI , waist circumference , dietary quality measured by digital photography , satisfaction with life assessed with a scale , and work routines assessed with a question naire . Outcomes were related to intervention fidelity . A positive intervention effect was found on physical activity , with an average increase of 1608 steps/day among participants in the intervention group ( P=0.045 ) . The effect size was 0.29 ( Cohen 's d ) . The type of residence was found to be an effect moderator . A positive intervention effect was found as well on work routines , with an average increase of 7.1 percentage points on a self- assessment scale among residences in the intervention group ( P=0.016 ) . No significant effects were found on BMI , waist circumference , dietary quality , or satisfaction with life . In conclusion , this innovative intervention was effective in improving physical activity and work routines . It is likely that even greater effects could be achieved by improvements in implementation strategies , leading to higher fidelity BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . This paper describes PEDro , the Physiotherapy Evidence Data base . PEDro is a web-based data base of r and omized controlled trials and systematic review s in physiotherapy . It can be accessed free of charge at http://ptwww.cchs.usyd.edu.au/pedro . The data base contains bibliographic details and abstract s of most English- language r and omized trials and systematic review s in physiotherapy , and of many trials and review s in other language s. Trials on the data base are rated on the basis of their method ological quality so that users of the data base can quickly identify trials of high quality . Trials and systematic review s are extensively indexed to facilitate search ing . PEDro provides an important information re source to support evidence -based clinical practice Attitudinal and psychosocial outcomes of a fitness and health education program for adults with Down syndrome were examined . Participants were 53 adults with Down syndrome ages 30 years and older ( 29 females , 24 males , M age = 39.72 years ) who were r and omized into a training ( n = 32 ) or control group ( n = 21 ) . The training group participated in a 12-week , 3 days per week , exercise and health education program . Outcome measures included attitudes towards exercise ( cognitive-emotional barriers , outcomes expectations , and performance self-efficacy ) and psychosocial well-being ( community integration , depression , and life satisfaction ) . Compared to controls , the training group showed significant changes in attitudes towards exercise , including increased exercise self-efficacy , more positive expected outcomes , fewer cognitive-emotional barriers , improved life satisfaction , and marginally lower depression Background People with Down syndrome ( DS ) display consistent patterns of physical inactivity . If these sedentary behaviors continue over extended periods of time , there will be negative health consequences . Objective The objective of this study was to investigate the physical activity and health-related outcomes of teaching children with DS to ride a 2-wheel bicycle . Design This study was a r and omized intervention in which the control group waited 1 year to receive the intervention . Setting This intervention study was conducted in a community setting . Participants The participants were children who were 8 to 15 years of age and who had been diagnosed with DS . Intervention The participants were r and omly assigned to an experimental group ( bicycle intervention ) or a control group ( no intervention ) . Measurements Measurements were obtained in the month before the intervention ( preintervention ) , at 7 weeks after the intervention , and at 12 months after the preintervention measurement for all participants . Results The results indicated no group differences at the preintervention session . Fifty-six percent of the participants in the experimental group successfully learned to ride a 2-wheel bicycle during the 5-day intervention . Analysis showed that participants who learned to ride spent significantly less time in sedentary activity at 12 months after the preintervention measurement and more time in moderate to vigorous physical activity than participants in the control group . Body fat appeared to be positively influenced over time in participants who learned to ride . Limitations It is unknown how frequently the children in the experimental group rode their bicycles after the intervention . Conclusions Most children who are 8 to 15 years of age and who have been diagnosed with DS can learn to ride a 2-wheel bicycle . Learning to ride can reduce time spent in sedentary activity and increase time spent in moderate to vigorous physical activity , which may influence the health and functioning of these children
BACKGROUND People with intellectual disabilities ( ID ) experience more health problems and have different lifestyle change needs , compared with the general population .
AIMS To improve lifestyle change interventions for people with ID , this review examined how behaviour change techniques ( BCTs ) were applied in interventions aim ed at physical activity , nutrition or physical activity and nutrition , and described their quality .