Needs of Direct Support Professionals to Support People With Intellectual Disabilities in Leading a Healthy Lifestyle

Background For a healthy lifestyle, people with moderate, severe, and profound intellectual disabilities living in residential facilities and/or participating in day activity centers are dependent on their direct support professionals. However, it is unclear what knowledge and skills these direct support professionals require to support these individuals in living a healthy lifestyle. Therefore, the aim of this study was to identify the needs of direct support professionals for supporting these people with moderate to profound intellectual disabilities to achieve and maintain a healthy lifestyle. Method Direct support professionals (n = 28) were interviewed with the use of a semi-structured protocol based on the theoretical domains framework. The interviews were analyzed with a theory-driven content analysis. Results The most frequently mentioned needs referred to the following domains of the theoretical domains framework: environmental context and resources (n = 27), social/professional role and identity (n = 25), social influence (n = 25), skills (n = 24), and knowledge (n = 23). Conclusion To support people with moderate to profound intellectual disabilities in leading a healthy lifestyle, direct support professionals (DSPs) primarily needed support related to the domain environmental context and resources. Within this domain available time, dealing with different seasons, and a healthy lifestyle policy in the organization need attention. Development of interventions targeting these DSPs needs is required

Is fatness or fitness key for survival in older adults with intellectual disabilities?

Background: Overweight/obesity and poor physical fitness are two prevalent lifestyle-related problems in older adults with intellectual disabilities, which each require a different approach. To improve healthy ageing, we assessed whether fatness or fitness is more important for survival in older adults with intellectual disabilities. Methods: In the HA-ID study, we measured obesity and fitness of 874 older adults with intellectual disabilities (61.4 ± 7.8 years). Alsl-cause mortality was assessed over a 5-year follow-up period. Results: Fitness, but not obesity, was significantly related to survival (HR range of 0.17–0.22). People who were unfit were 3.58 (95% CI = 1.72–7.46) to 4.59 (95% CI = 1.97–10.68) times more likely to die within the follow-up period than people who were fit, regardless of obesity. Conclusion: This was the first study to show that being fit is more important for survival than fatness in older adults with intellectual disabilities. The emphasis should, therefore, shift from weight reduction to improving physical fitness

Use of behaviour change techniques by direct support professionals to support healthy lifestyle behaviour for people with moderate to profound intellectual disabilities

Background Behaviour change techniques (BCTs) can be employed to support a healthy lifestyle for people with intellectual disabilities. The aim of this study is to determine whether and which BCTs are used by direct support professionals (DSPs) for supporting healthy lifestyle behaviour of people with moderate to profound intellectual disabilities. Method Direct support professionals (n = 18) were observed in their daily work using audio-visual recordings. To code BCTs, the Coventry Aberdeen London Refined (CALO-RE-NL) taxonomy was employed. Results Direct support professionals used 33 BCTs out of 42. The most used BCTs were as follows: 'feedback on performance', 'instructions on how to perform the behaviour', 'doing together', 'rewards on successful behaviour', 'reward effort towards behaviour', 'DSP changes environment', 'graded tasks', 'prompt practice' and 'model/demonstrate behaviour'. Conclusions Although a variety of BCTs is used by DSPs in their support of people with moderate to profound intellectual disabilities when facilitating healthy lifestyle behaviour, they rely on nine of them

Improving Environmental Capacities for Health Promotion in Support Settings for People with Intellectual Disabilities: Inclusive Design of the DIHASID Tool

People with intellectual disabilities (ID) have unhealthier lifestyles than the general population. To sustainably improve their lifestyle and health status, a whole-system approach to creating healthy environments is crucial. To gain insight into how support for physical activity and healthy nutrition can be embedded in a setting, asset mapping can be helpful. Asset mapping involves creating a bottom–up overview of promoting and protective factors for health. However, there is no asset mapping tool available for ID support settings. This study aims to develop an asset mapping tool in collaboration with people with ID to gain insight into assets for healthy nutrition and physical activity in such settings. The tool is based on previous research and development continued in an iterative and inclusive process in order to create a clear, comprehensive, and usable tool. Expert interviews (n = 7), interviews with end-users (n = 7), and pilot testing (n = 16) were conducted to refine the tool. Pilot participants perceived the tool as helpful in pinpointing perceived assets and in prompting ideas on how to create inclusive environments with support for physical activity and healthy nutrition. This overview of assets can be helpful for mobilizing assets and building the health-promoting capacities of ID support settings

Physical fitness of children and adolescents with moderate to severe intellectual disabilities

Background: Low levels of physical fitness are associated with low physical and mental health. The aims of this study were to assess the health-related physical fitness of children with intellectual disability (ID), and study the association of physical activity and motor development with physical fitness. Methods: One hundred and twenty-eight children with moderate to severe ID (83 boys; age 2–18 years) visiting specialised day programme centres engaged in field-based physical fitness tests (body composition, muscular strength, muscular endurance, and cardiorespiratory fitness). Scores were compared to reference values, and with linear regression analysis the association between the fitness outcomes and physical activity and motor development was studied. Results: High rates of overweight (23–25%) and obesity (10–15%) were found. A majority of the participants (71–91%) scored below reference values for muscular strength, endurance, and cardiorespiratory fitness tests. Physical activity and motor development were positively associated with scores on several fitness test (β = 0.27–0.44; p < 0.05). Conclusions: Children with moderate to severe ID visiting specialised day programme centres have strikingly low physical fitness levels. Policies and interventions to increase the physical fitness for this specific group of children are urgently needed, in which increasing physical activity and motor skills are expected to be effective components

Correlates of Sedentary Behaviour in Adults with Intellectual Disabilities-A Systematic Review

Individuals with intellectual disabilities (ID) are at high risk for high levels of sedentary behaviour. To inform the development of programmes to reduce sedentary behaviour, insight into the correlates is needed. Therefore, the aim of this study is to review the evidence on correlates of sedentary behaviour in adults with ID. We performed a systematic literature search in Ovid Medline, Ovid Embase, Web of Science and Google Scholar up to 19 January 2018, resulting in nine included studies that were published from 2011 to 2018. Correlates were categorized according to the ecological model. Studies predominantly focused on individual level correlates. Of those correlates studied in more than one study, having epilepsy was associated with less sedentary behaviour and inconsistent results were found for sex, genetic syndromes, weight status, physical health, mobility, level of ID, and mental health. Of the few interpersonal and environmental factors studied, only living arrangements were studied in more than one study, with inconsistent results. To date, we have limited and inconclusive evidence about correlates of sedentary behaviour in adults with ID. Only when future studies unravel correlates and determinants, across all domains of the ecological model, will the potential opportunities to improve health by reducing sedentary behaviour come within reach

Feasibility of Eight Physical Fitness Tests in 1,050 Older Adults with Intellectual Disability:Results of the Healthy Ageing with Intellectual Disabilities Study

<p>Although physical fitness is relevant for well-being and health, knowledge on the feasibility of instruments to measure physical fitness in older adults with intellectual disability (ID) is lacking. As part of the study Healthy Ageing with Intellectual Disabilities with 1,050 older clients with ID in three Dutch care services, the feasibility of 8 physical fitness tests was expressed in completion rates: box and block test, response time test, Berg balance scale, walking speed, grip strength, 30-s chair stand, 10-m incremental shuttle walking test, and the extended modified back saver sit and reach test. All tests had moderate to good feasibility in all subgroups, except for the participants with profound ID (all tests), severe ID (response time test and Berg balance scale), and wheelchair users (all tests that involve the legs). We conclude that the 8 tests are feasible to measure physical fitness in most older adults with ID.</p>

Subgroups associated with lower physical fitness in older adults with ID:Results of the HA-ID study

Although physical fitness is generally very low in older adults with intellectual disabilities (ID), levels may differ across subgroups. It is important to identify which subgroups need to be targeted specifically in physical activity and fitness interventions and reference values. Physical fitness was measured with box-and-block-test, response-time-test, Berg-balance-scale, walking speed, grip strength, 30 s-chair-stand, 10 m incremental-shuttle-walking test and the extended modified-back-saver-sit-and-reach-test in a large sample of older adults with ID (n = 1050), and subgroups associated with lower physical fitness levels were identified applying multivariate linear regression analyses. Both fixed personal characteristics such as being older, being female, having more severe ID and having Down syndrome and modifiable or preventable factors such as physical activity levels, mobility impairments and a need of more intensive care, are independently associated with lower levels of multiple physical fitness components. This first study identifies subgroups of older adults with ID which require adapted reference values, and subgroups that need to be specifically targeted in fitness promotion programs. (C) 2013 Elsevier Ltd. All rights reserved

Physical fitness in older people with ID-Concept and measuring instruments:A review

A certain level of physical fitness is a prerequisite for independent functioning and self-care, but the level of physical fitness declines with ageing. This applies to older adult with intellectual disabilities too, but very little is known about their actual level of physical fitness. This lack of knowledge is partly caused by a lack of suitable instruments to measure physical fitness in this group, but the search for and choice of instruments depends on the operationalisation of the concept physical fitness for specific this target population. In this article the advantages of two known definitions of physical fitness are combined, leading to a combination of seven components to describe physical fitness in older adults with intellectual disabilities: coordination, reaction time, balance, muscular strength, muscular endurance, flexibility and cardio-respiratory endurance. A literature search for all instruments to measure any of these components resulted in a large number of available instruments. These instruments were evaluated according criteria of functionality, reliability and feasibility in this target population. The aim of this article was to propose a selection of instruments which complied with these criteria and creates possibilities for widespread use and sharing and/or pooling of data. The proposed selection of tests to measure physical fitness in older adults with intellectual disabilities is: Box and Block test, Reaction time test with an auditive and visual signal, Berg balance scale, Walking speed comfortable and fast, Grip strength with a hand dynamometer, 305 chair stand, modified back saver sit and reach and the 10 m incremental shuttle walking test. (C) 2010 Elsevier Ltd. All rights reserved

(Instrumental) activities of daily living in older adults with intellectual disabilities

Daily living skills are important to ageing adults with intellectual disabilities (ID). The purpose of this study was to investigate the level of these skills in older adults with ID and to investigate the influence Of gender, age, level of ID and mobility on these skills. Daily living skills were measured with the Barthel Index (for Activities of Daily Living, ADL) and. the Lawton IADL scale (for Instrumental Activities of Daily Living, IADL) in 989 adults with ID aged 50 years and over living in community-based and institutional settings. Descriptives were presented by categories of gender, age, level of ID and mobility. Regression analysis was used to investigate the influence of these variables on total and item scores of ADL and IADL questionnaires. ADL and IADL scores in older adults with ID are comparable to those of vulnerable patient groups. Total ADL score was mainly determined by mobility, while total IADL score was mainly determined by level of ID. Of all 18 separate items of these questionnaires, 11 were determined more by mobility than level of ID. The Barthel Index and Lawton IADL scale are recommended for future use in research and clinical practice in this group. This study stresses the need to support mobility older adults with ID as much as possible, in order to optimalize independency in this group. (C) 2011 Elsevier Ltd. All rights reserved