Physical Activity Promotion for Persons Experiencing Disability: The Importance of Interdisciplinary Research and Practice.

This paper examines the need for interdisciplinary knowledge in the formation of public health models for health-promoting physical activity (PA) for people experiencing disability. PA promotion for people experiencing disability is a multifaceted endeavor and requires navigating a multitude of complicated and interactive factors. Both disability and health are multifaceted constructs and the relationship between PA and health is embedded within a complicated web of interactive influences. PA promotion must consider interacting biological and psychosocial factors within the person and in the sociopolitical environment. Models for research and practice need to evolve from value and belief systems that center on people experiencing disability without stigmatizing them. We argue that interdisciplinary research and practice is needed in navigating the intricacies of PA promotion toward improving the health of people experiencing disability and facilitating inclusion, empowerment, and dignity.

Prediction of energy expenditure during walking in adults with down syndrome.

BACKGROUND: When developing walking programmes for improving health in adults with Down syndrome (DS), physical activity professionals are in need of an equation for predicting energy expenditure. We therefore developed and cross-validated an equation for predicting the rate of oxygen uptake (VO2 ; an index of energy expenditure) for adults with and without DS. METHOD: A total of 469 VO2 observations during walking across different speeds were available from 54 adults with DS and 61 adults without DS. RESULTS: Significant predictors of VO2 were speed, speed square, group and group-by-speed interaction. Separate models for each group showed that speed and its square significantly predicted VO2 . Absolute per cent error was small and did not differ between groups. CONCLUSION: Adults with DS have different VO2 response to walking speed from persons without DS. VO2 is predicted from speed with acceptable accuracy for persons with DS.

Gait characteristics of adults with Down syndrome explain their greater metabolic rate during walking.

The altered gait patterns of adults with Down syndrome (DS) may contribute to their higher net metabolic rate (net-MR) during walking than adults without DS, leading to mobility limitations. This study examined the extent to which gait characteristics explain differences in net-MR during walking between adults with and without DS. Fifteen adults with DS (27 ± 8 years) and 15 adults without DS (28 ± 6 years) completed two testing sessions in which expiratory gases and kinematic data were collected, respectively, during treadmill walking. Participants walked at six, randomly-presented dimensionless speeds, ranging from slow to fast. Hierarchical and stepwise regressions were used to determine the proportion of the variance in net-MR explained by gait variables that differed between groups, after controlling for variance due to walking speed. Positive work rate, the range of the body center of mass (COM) mediolateral position and its square, variability in the time-course of COM anteroposterior velocity, and the variability of step length, step width, and step time significantly predicted net-MR (p < .05). These variables collectively explained 73.9% of the variance in net-MR that was explained by DS but not by walking speed. After accounting for shared variance among predictors, step length variability made the greatest unique contribution (10.6%) to the higher net-MR in adults with DS, followed by the range of COM mediolateral motion (6.3%), step width variability (2.8%), and variability in COM anteroposterior velocity (0.7%). Therefore, the gait characteristics of adults with DS appear to largely explain their higher net-MR during walking.

Validity evidence for self-report with assistance to measure physical activity behavior in adults with intellectual disabilities.

Self-reported physical activity (PA) behavior with assistance from a secondary source has previously been used with adults with an intellectual disability (ID). Limited evidence of reliability and validity have been provided for this approach. This study examined evidence of convergent (CV) and discriminant (DV) validity for self-report with assistance from a secondary source as a measure of PA in adults with ID. PA of 37 participants with ID were assessed using (a) self-report, (b) accelerometers, and (c) pedometers. The multitrait-multimethod (MTMM) analysis was used to evaluate validity. MTMM analysis revealed high reliability among variables, low to strong CV, and moderate DV. The study outcomes provide initial convergent and discriminant validity evidence for this measure of PA in adults with ID.

The ambiguous role of the paraeducator in the general physical education environment.

The use of paraeducators has increased as a main mechanism to include more students with disabilities in the public schools in the U.S. Although the utilization of paraeducators is intended to be a supportive service delivery option, many concerns and challenges have resulted. The purpose of this study was to examine the role of the paraeducator in the general physical education environment from the perspectives of special education, physical education, and adapted physical education teachers and paraeducators. Data were collected from a phenomenological approach using questionnaires, interviews, and observations. Results indicate concerns about the clarity of the role of the paraeducator in physical education. Emerging themes include elastic definitions of student protection and teacher backup, contradictory expectations and mixed acceptance, and paraeducators' role ambiguity. Findings regarding the role of the paraeducator are essential in determining both best practice and legal policy for the appropriate utilization of paraeducators in physical education.

Physical activity and nutrition health promotion interventions: what is working for people with intellectual disabilities?

A scoping review of studies on physical activity and nutrition health promotion interventions for individuals with intellectual disabilities was conducted. Searches included MEDLINE, PsycINFO, and CINAHL databases from 1986 through July 2006. The final number included 11 articles comprising 12 studies. Generally, this review indicated some evidence for fitness and psychosocial benefits of community-based physical activity and exercise programs for adults with intellectual disabilities. When combined with a more comprehensive health behavior education program incorporating exercise and nutrition information, some evidence exists for reductions in weight.

Physical fitness and physical activity in adolescents with asperger syndrome: a comparative study.

While physical activity is beneficial for youth with developmental disabilities, little is known about those individuals' fitness profile and levels of activity. Therefore the purpose of this study was to investigate the physical fitness profile and physical activity level of 30 adolescents with and without Asperger syndrome (AS). Evaluations were done using the Eurofit physical fitness test and the Baecke Habitual Physical Activity questionnaire. A 2 x 2 MANOVA indicated that adolescents with AS scored significantly lower than the comparison group on all physical fitness subtests, including balance, coordination, flexibility, muscular strength, running speed, and cardio-respiratory endurance (p < .001). Adolescents with AS were also less physically active (p < .001). Engagement in physical activities is therefore recommended.

Exercise intervention research on persons with disabilities: what we know and where we need to go.

The purpose of this article was to provide a comprehensive review of the exercise intervention literature on persons with physical and cognitive disabilities. Electronic searches were conducted to identify research articles published from 1986 to 2006. Of the 80 physical activity/exercise interventions identified in the literature, only 32 were randomized controlled trials. The remaining studies were nonrandomized controlled trials with (n = 16) and without (n = 32) a control group. There was a mixture of exercise training modalities that involved aerobic (26%), strength (25%), and combined aerobic and strength (23%) exercises, but there were no overlapping studies using the same dose of exercise for any of the 11 disability groups. Almost half the studies targeted stroke (20%), multiple sclerosis (15%), and intellectual disability (13%), with significantly fewer studies targeting other disability groups. The current literature on exercise and disability is extremely broad in scope and has limited generalizability to any specific disability group. A new body of evidence is needed with stronger research designs that adhere to precise dosing characteristics for key health outcomes (e.g., pain/fatigue reduction, improved cardiorespiratory health). Multicenter trials will be needed for low-prevalence populations to strengthen research designs and increase generalizability of study findings.

Effects of Down syndrome on three-dimensional motion during walking at different speeds.

The inherent joint laxity and muscle hypotonia of adults with Down syndrome (DS) may result in reduced gait stability and increased energetic cost. These factors vary as a function of walking speed and may be reflected in gait patterns. The present study therefore examined whether the three-dimensional motion of the body center of mass (COM) and stepping characteristics differ between adults with and without DS as a function of speed. Fifteen adults with DS and 15 adults without DS underwent a series of treadmill walking trials. Walking speeds were determined as Froude numbers, based on leg length. Participants walked at Froude numbers of 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, and, for adults without DS, 0.7. Whole-body kinematic data were collected for 30-35 steps at each speed. Across speeds, adults with DS showed greater and more variable mediolateral COM motion than adults without DS. COM anteroposterior velocity and vertical motion did not differ in range between groups, but were more variable in adults with DS. Adults with DS also showed smaller-duration steps and varied their step widths and step lengths more than adults without DS. The results suggest a gait pattern with lesser stability and greater energetic cost among adults with DS.

Economy and preferred speed of walking in adults with and without Down syndrome.

This study examined whether the net rate of oxygen uptake (VO2net) and the net oxygen uptake per kilometer (VO2net/km) are affected during walking in adults with Down syndrome (DS) and whether their preferred walking speed (PWS) minimizes the VO2net/km. Respiratory gases were collected as 14 adults with DS and 15 adults without DS completed a series of treadmill walking trials. PWS was measured over 15 meters in a hallway. The VO2net and the VO2net/km were higher in adults with DS than adults without DS. The overground PWS normalized for leg length was the same for both groups and did not appear to minimize the VO2net/km. Thus, adults with DS are less economical during walking than adults without DS. The overground PWS does not minimize the metabolic cost during treadmill walking.

An exploratory study of after-school sedentary behaviour in elementary school-age children with intellectual disability.

BACKGROUND: The purpose of this study was both to investigate if children with intellectual disability (ID) spend more time watching television and on the computer than their peers without disabilities and if total screen time correlates with physical activity in these same children. METHODS: Participants were 9 children with ID matched with 9 children without ID, aged 7-12 years. Participants were matched by gender, age, and body mass index (BMI). Parents logged after-school television and computer time. Physical activity was recorded with accelerometers. RESULTS: Mann-Whitney tests revealed no difference between television or computer time between the groups. Correlations between physical activity and screen time revealed that children without ID had a low relationship between physical activity and screen time (tau = -.11, p = .64). Conversely, children with ID had a moderate relationship between physical activity and screen time (tau = .56, p = .04). CONCLUSIONS: These results suggest that there might be different patterns of sedentary behaviours between children with and without ID, indicating that unique interventions may be needed for individuals with ID.

Psychosocial predictors of physical activity and health-related quality of life among adults with physical disabilities: an integrative framework.

BACKGROUND: People with disabilities report lower physical activity (PA) and health-related quality of life (HRQOL) levels than people without disabilities. Therefore, it is important to identify factors that motivate individuals with disabilities to be physically active and thus increase their HRQOL. OBJECTIVES: The purpose of the study was to prospectively explore the effects of past theory of planned behavior (TPB) constructs on future (6-month) HRQOL (physical and mental health) through past stages of change (SOC) and future (6-month) PA among adults with physical disabilities. Two models were tested whereby the SOC and PA served as the mediators between the TPB constructs, physical health (PH-Model), and mental health (MH-Model). It was hypothesized that both models would fit the sample data. METHODS: Participants were 141 adults with physical disabilities (mean age = 46.04, females = 70.9%). The online survey was completed at two different time periods. First, the TPB constructs and SOC were assessed using self-report standardized questionnaires. Six months later, participants completed standardized self-report scales about their PA and HRQOL levels. Using LISREL 8, two path analyses were conducted to examine the two study models (PH-Model and MH-Model). RESULTS: Based on the two path analyses, attitude had the highest effect on SOC followed by perceived behavioral control within both well-fit models. The PH-Model explained more variance in PA (26%) and physical health (55%) than the MH-Model. CONCLUSIONS: Health promoters should reinforce both positive intentions and behavioral experiences to increase PA and HRQOL among adults with physical disabilities.

Gait transitions of persons with and without intellectual disability.

This study examined whether the walk-to-run transition speed (W-RTS) and the run-to-walk transition speed (R-WTS) were different or more variable between participants with and without intellectual disability (ID). Nine adults with ID and 10 adults without ID completed in a series of walk-to-run and run-to-walk trials on a treadmill. W-RTS and R-WTS were identified using force-sensitive resistors. When transition speeds were expressed as Froude numbers to account for differences in leg length, W-RTS was slower and intraindividual variability of W-RTS and R-WTS was greater in participants with ID. These findings support the idea that the unique constraints of individuals with ID result in altered attractor dynamics for walking and a weaker coupling between locomotor speed and order parameters governing gait transitions.

Dietary intake of adults with mental retardation who reside in community settings.

The dietary intake of adults with mental retardation among three different community residential settings was described and compared. Two dietary screeners were administered to 325 adults. The women's Fruit and Vegetable Screener scores from group homes were significantly higher than scores from those with family members and in semi-independent settings. No significant differences were found in dietary intake across residences for men. Overall, 0% to 6% of the participants consumed the recommended 5 or more fruits and vegetables per day, and 15% to 30% consumed the recommended

Physical activity beliefs and behaviour of adults with physical disabilities.

PURPOSE: The purpose of this study was to elicit the physical activity (PA) beliefs from adults with physical disabilities; and second, to examine their self-reported PA participation. METHOD: Participants were 223 adults (M age = 45.4 years, SD = 10.8), with self-reported physical disabilities who completed a web-based survey. Six open-ended questions were used to assess PA beliefs and the PA Scale for Individuals with Physical Disabilities measured self-reported PA. RESULTS: A qualitative analysis showed that the most accessible behavioural advantages are that PA improves emotional functioning and assists with weight management. The most accessible behavioural disadvantages are that PA causes pain or soreness and consumes time. The most accessible normative influences that approve of PA are family, friends, and healthcare professionals. The most accessible control beliefs obstructing PA are disability and associated symptoms, and a lack of access to adequate facilities, equipment, or programs. The most accessible control beliefs that facilitate PA are access to adequate facilities, equipment, or programs, and support or assistance. Finally, the average total PA score was 20.5 metabolic equivalent (METS)-hours/day (SD = 16.8). CONCLUSIONS: Adults with physical disabilities possess unique PA beliefs that can be used to design health promotion interventions to increase PA participation.

The mediating role of intention and stages of change in physical activity among adults with physical disabilities: an integrative framework.

The study's purpose was to identify the mediating role of intention and the stages of change (SOC) in physical activity (PA) over a 6-month period using two models (theory of planned behavior [TPB] and TPB/SOC). Participants were 143 adults with physical disabilities (70.68% response rate; M age = 46.03). The TPB constructs, SOC (time 1), and PA (time 2) were assessed using standardized self-report questionnaires. Based on path analyses, attitude had the highest effect on intention and SOC followed by perceived behavioral control within both well-fit models. The variance in PA explained by the first (TPB) and second (TPB/SOC) models was 16% and 28% respectively. In the just identified model of TPB/SOC, the direct effect of SOC on physical activity remained strong (gamma(soc.pa) = .45) and SOC approached full mediation through attitude. Health promotion interventions need to include both intention and behavior elements (SOC) reinforcing increased PA value and barrier elimination.

Fitness, inflammation, and the metabolic syndrome in men with paraplegia.

OBJECTIVE: To determine the relations among peak aerobic capacity, physical activity, functional ability, components of the metabolic syndrome (high-density lipoprotein cholesterol [HDL-C], triglycerides [TG], glucose, insulin, abdominal obesity, high blood pressure), and inflammatory factors (interleukin-6 [IL-6], C-reactive protein [CRP]) in men with paraplegia. DESIGN: Cross-sectional exploratory design. SETTING: University research laboratory. PARTICIPANTS: Twenty-two men (age, 39+/-9y; duration of injury, 17+/-9y; level of injury, T2-L2) with functionally complete paraplegia volunteered to participate. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Peak aerobic capacity was measured using a graded peak exercise test with an arm ergometer, and physical activity was assessed by the Physical Activity and Disability Scale. Functional ability was assessed by the Self-Report Functional Measure. Circulating glucose, insulin, HDL-C, TG, total cholesterol, IL-6, and CRP levels were determined by specific enzyme or immunologic assays. Body fat was determined by dual-energy x-ray absorptiometry, and central obesity was estimated from abdominal sagittal diameters. RESULTS: Lower peak aerobic capacities were associated with lower HDL-C and lower physical activity levels ( P <.014). Lower physical activity levels were associated with higher fasting glucose, lower HDL-C level, and larger abdominal sagittal diameters ( P <.036). Larger abdominal sagittal diameters were associated with higher fasting glucose, higher fasting and postload insulin, lower HDL-C, higher TG, and higher CRP levels ( P <.05). CONCLUSIONS: Diet and exercise trials are needed to determine the efficacy and effectiveness of lifestyle interventions aimed at slowing the progression of the metabolic syndrome in people with spinal cord injury.

A pilot study of a web-based physical activity motivational program for adults with physical disabilities.

PURPOSE: Develop, deliver, and assess the efficacy of a 4-week web-based leisure-time physical activity (LTPA) motivational program based on the Transtheoretical Model and tailored to inactive adults with physical disabilities. METHOD: This was a pilot-based study incorporating a true experimental design with one treatment and one control group. The intervention program was delivered on the web and was based on the constructs of the Transtheoretical Model. From the 151 individuals who completed the LTPA standardized questionnaire at baseline, 75 people participated in the 1-month post-test assessment. RESULTS: The results of the analysis confirmed the pretest LTPA scores as the study covariate for the post-test assessment (F (1,72)=16.06, p=0.001, (2 )= 0.18). Based on the one-way ANCOVA, there were no statistically significant differences in LTPA scores between the treatment and control groups at post-test. However, the corresponding effect size and variance explained by the treatment approached a moderate level of significance (d=0.34 and (2 )= 0.04). CONCLUSIONS: Although conclusive statements about program effectiveness cannot be secured, several 'lessons learned' from this project may be 'key factors' for program improvement. Given the pilot nature of the study and the limited resources for program development and monitoring, continued examination of such motivational materials and delivery mechanisms for people with physical disabilities appear warranted.

Predictors of physical activity stage of change among adults with physical disabilities.

PURPOSE: To use the Transtheoretical Model (TTM) constructs to examine the most important physical activity stage of change predictors for mostly inactive adults with physical disabilities. METHODS: A cross-sectional survey completed on the Internet. One hundred fifty-one individuals with physical disabilities (50% response rate) completed the survey questionnaires. Self-report standardized measures were used. RESULTS: A direct discriminant function analysis revealed that the most important stage of change predictors were the behavioral (r2 = .88) and cognitive (r2 = .50) processes of change, followed by self-efficacy (r2 = .33) and decisional balance (r2 = .13). The most accurate stages in prediction were the contemplation (76.3%), preparation (58.3%), and precontemplation (40%) stages, whereas the least accurate stages were the action (0.0%) and maintenance (8.3%) stages. CONCLUSION: Health promoters and educators may use strategies from the TTM to develop theory-driven physical activity motivational programs for the posited populace. Considering the cross-sectional design, study replication is warranted.