Published for the British Institute of Learning Disabilities

Journal of Applied Research in Intellectual Disabilities 2015

BRIEF REPORT

Physical Activity Levels Among Adolescent and Young Adult Women and Men with and without Intellectual Disability Lina Sundahl*, Marie Zetterberg*, Anita Wester†, B€ orje Rehn* and Sven Blomqvist‡ *Department Community Medicine and Rehabilitation, Physiotherapy, Ume a University, Ume a, Sweden; †Department of Research and Evaluation, Swedish National Agency for Education, Stockholm, Sweden; ‡Swedish Development Centre for Disability Sport, Bolln€as, Sweden

Accepted for publication 8 July 2014

Background As physical activity can prevent overweight and promote general health, the aim was to investigate the amount of physical activity among adolescent and young adult women and men with intellectual disability (ID), compared to age-matched control groups without intellectual disability. A further aim was to examine whether physical activity level was associated with the body mass index (BMI). Materials and methods Fifty-two adolescent and young adult women and men with intellectual disability and 48 without intellectual disability, between the ages 16 and 20 years, BMIs ranging from 16.3 to 50.3 kg/m2, were measured for number of steps taken with a pedometer for five consecutive days (Sunday–Thursday).

Introduction Persons with intellectual disability (ID) have a generally increased vulnerability to physical illness, such as overweight/obesity, type II diabetes, heart disease and muscle disease (Umb-Carlsson 2008). This makes it important to investigate physical activity levels, as physical activity can promote good general health and prevent some of these diseases (St ahle 2010). Physical activity is, according to the Swedish National Institute of Public Health (Nilsson 2010), defined as any type of body movement performed by skeletal muscles that increases energy consumption. Recommendations

Brief Report prepared for Journal of Applied Research in Intellectual Disabilities (JARID).] © 2015 John Wiley & Sons Ltd

Results The only group to meet recommendations regarding number of steps (10 000–12 000/day) was women without intellectual disability. No significant associations were found between total number of steps taken and BMI. Conclusion As the majority of adolescents and young adults with intellectual disability, especially women, did not reach recommended activity levels regardless of their BMIs, this call for broad measures to increase physical activity. Keywords: mental retardation, motor activity, teenagers, youths

regarding the number of steps a person should take every day to avoid overweight and obesity, defined by the body mass index (BMI), range from 8000 to 12 000, with a higher amount for adolescents, 10 000–12 000 steps (Tudor-Locke et al. 2008a). However, children and older adults with intellectual disability have shown lower physical activity levels compared to peers without intellectual disability (Hilgenkamp et al. 2010; Hinckson & Curtis 2013) and also a higher BMI (Hsieh et al. 2014). BMI has shown some association with physical activity level (Bailey et al. 2013). No study has been found that uses direct methods to assess physical activity levels among adolescents and young adults with intellectual disability, an age where physical activity habits are established (Malina 2001). There seem to be gender differences with regards to physical activity (Rauner et al. 2013). 10.1111/jar.12170

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The aim of this study was to investigate the number of steps taken among adolescent and young adult women and men with intellectual disability, compared to age-matched control groups without intellectual disability. A further aim was to examine whether number of steps taken was associated with the BMI. The hypotheses were that adolescents and young adults with intellectual disability would take fewer steps and that this would be associated with their BMIs.

Materials and Methods Participants The participants were a convenience sample of adolescents and young adults, 52 with intellectual disability and 48 without intellectual disability. The 52 participants with intellectual disability included 27 females and 25 males. The 48 participants without intellectual disability included 21 females and 27 males. They were all recruited from two schools in Bolln€ as, a small city in the middle of Sweden. Participants were between 16 and 20 years old (Table 1). Inclusion criteria were that the intellectual disability should be mild (IQ = 50–69) to moderate (IQ = 35–49). Exclusion criteria for both groups were as follows: neurological signs in the lower extremities (loss of sensory functions, reduced

isometric strength or affected stretch reflexes); injury to the lower extremities; reduced vision (more than 90% reduced, the visual acuity was measured with a vision chart); former or current vestibular neuritis; diagnosed cerebral palsy; and the use of walking aids. The school for students with intellectual disability has a student intake from the entire country, which means that the students with intellectual disability had moved away from home to live in managed housing with accommodation staff as caregivers and to basically learn how to care for themselves. Upon intake, the IQ is determined routinely by a psychologist. Many of the students travel to their home town on the weekends to be with their families. Most participating students without intellectual disability already live in Bolln€ as at home with their parents.

Physical activity measurements Physical activity was measured with two pedometers, the Keep Walking LS2000 and LS7000 (Yamax SW200/ LS2000). The pedometers measured every step and used no filter function. The SW series has performed well in previous validation [ICC – intraclass correlation coefficients (95% CI) = 0.98 (0.94, 0.98)] and reliability studies (Chronbach’s alpha = 0.992) (Crouter et al. 2003; Schneider et al. 2003).

Table 1 Comparison of participatory adolescent and young women and men with and without intellectual disability (ID); age, height, weight and body mass index (BMI)

All participants Age (year) Height (cm) Weight (kg) BMI (kg/m2) Women Age (year) Height (cm) Weight (kg) BMI (kg/m2) Men Age (year) Height (cm) Weight (kg) BMI (kg/m2)

Participants with intellectual disability

Participants without intellectual disability

Mean (SD)

Mean (SD)

n = 52 18.2 (1.2) 170.2 (8.9) 69.9 (18.6) 24.0 (5.6) n = 27 18.0 (1.3) 164.8 (6.0) 68.0 (21.1) 24.8 (6.5) n = 25 18.4 (1.0) 175.9 (7.9) 71.9 (15.6) 23.2 (4.5)

Median (min–max)

18.0 169.0 65.3 22.7

(16.0–20.0) (152.0–190.0) (43.0–152.3) (16.3–50.3)

18.0 164.5 63.0 22.5

(16.0–20.0) (152.0–178.5) (48.9–152.3) (18.0–50.3)

19.0 176.5 67.3 22.9

(16.0–20.0) (156.0–190.0) (43.0–107.5) (16.3–32.8)

n = 48 17.9 (0.9) 175.8 (9.3) 71.7 (13.0) 23.2 (3.9) n = 21 17.9 (0.9) 169.0 (7.8) 65.9 (9.1) 23.1 (3.1) n = 27 18.0 (0.9) 181.1 (6.5) 76.2 (14.0) 23.3 (4.4)

Median (min–max)

P-value

18.0 175.5 69.0 22.5

(16.0–20.0) (158.0–190.0) (52.8–130.3) (17.0–41.1)

0.220 0.004* 0.155 0.661

18.0 167.5 64.7 22.1

(16.0–20.0) (158.0–190.0) (52.8–84.1) (17.0–29.3)

0.041* 0.014* 0.272 0.862

18.0 182.5 75.5 22.6

(17.0–20.0 (167.5–190.0) (59.4–130.3) (17.4–41.1)

0.845 0.094 0.568 0.506

SD, standard deviation. *Significant at 0.05-level. © 2015 John Wiley & Sons Ltd

Journal of Applied Research in Intellectual Disabilities

Procedure Approval of the study was obtained from the Regional Ethical Review Board in Ume a, Sweden (No. 09-076M). All participants received verbal and written information about the project, and the parents of the participants with intellectual disability got written information. Both had to give written consent. Measurements were taken of their height (using a folding rule with the participants standing against a wall) and weight (with a portable scale – OBH Nordica 6212, CE marked). Clinical physical examinations for exclusion criteria were made by a registered physiotherapist (one of the authors). The participants were also asked about the number of physical exercise lessons they had every week. Participants were informed to wear the pedometer for five consecutive full days (Sunday– Thursday) in the month of February (winter season), from waking up until going to bed. The participants were further informed that the pedometer should be placed in the waistband in line with the knee. The pedometers should be reset every day, so each day could be analysed independently. Every morning the participants received a text message to their mobile phone to remind them to wear the pedometer. The participants had contact information for the test leaders so that they could get in touch with them if any problems occurred. A number of spare pedometers were available so that if a pedometer broke, it would immediately be replaced with a new one. Special attention was given to the participants with lower IQs so as to ensure that data collection was reliable. All participants received a diary. They were asked to write down information about physical activity, about any illness experienced and any problems with the pedometer. Information about the pedometer was also given to the parents, teachers and the staff at the managed care housing. They were also informed to remind the participants to wear their pedometers, help them with the diaries and to reset the pedometers every night.

Data analysis All participants with at least 3 days of pedometer data were included in the analysis. It has been shown that 3 days of measurement are necessary to predict the weekly number of steps (Tudor-Locke et al. 2005; Temple & Stanish 2009). Comparisons of age, height and weight between groups were made with the Mann– Whitney U-test, as the data for the chosen sample was © 2015 John Wiley & Sons Ltd

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not normally distributed. The total number of steps for the groups and comparison between the sexes were analysed with the independent samples t-test. To compare the number of steps taken each day for the groups, a general linear model (ANOVA with repeated measures) was chosen. Associations between BMI and total number of steps taken were analysed using Pearson’s correlation coefficient (rp). Significance refers to a P-value 50 000 steps in 5 days (Tudor-Locke et al. 2008b, 2011).

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Figure 1 Mean total number of steps and standard deviations for adolescents and young adults with and without intellectual disability (ID). Area marked with grey represents the recommended number of steps per day according to Tudor-Locke et al. (2008a, b). *Represents significant differences between groups and days (0.05-level).

No significant associations were found between BMI and total number of steps taken in any of the groups (Table 2).

Discussion This study showed that adolescent and young adult women with intellectual disability had a significantly lower physical activity level compared with agematched women without intellectual disability. Adolescent and young adult men with intellectual disability had equal number of steps taken compared to age-matched men without intellectual disability. One thing that could explain this diversity is that the women without intellectual disability more frequently, as shown in the diaries, had a scheduled leisure time activity with which they were physically active. Fewer women with intellectual disability had such leisure time activity which was a different situation compared to the male Table 2 Associations between body mass index (BMI) and total amount of steps taken for adolescent and young women and men (n = 100) with and without intellectual disability (ID) analysed using Pearson’s correlation coefficient (rp)

All participants Women Men

Participants with intellectual disability

Participants without intellectual disability

rp

rp

0.24 0.187 0.267

P-value 0.087 0.351 0.198

0.072 0.065 0.075

P-value 0.627 0.779 0.710

groups. Further, women with intellectual disability reported a higher rate of days of illness than the women without intellectual disability. A significantly lower number of steps were found for the participants with intellectual disability regarding the first day of measurement, Sunday. This result could indicate that adolescents with intellectual disability are not as physically active at home, where they are not encouraged to be active as they are while encouraged by PE teachers at their schools from Monday to Thursday. Physical activity levels have been shown to increase among adolescents wearing pedometers (Ho et al. 2013), which suggests that the real number of steps are actually less. This study support the idea that the lowered level of physical activity, seen in adults (Umb-Carlsson 2008), may already be starting in adolescence, especially for women. A recent study found that steps per day were related to body composition among college women aged 18–25 years (Bailey et al. 2013). Another also found an inverse relationship with steps taken and BMI, although among an older group of people (Pillay et al. 2013). The reason for why the present authors found no association among the group with intellectual disability is unclear. Apart from the linear analysis reported here, the present authors also made a stratified analysis (not reported) to compare the amount of steps among those with the highest and lowest BMI, although it did not alter the conclusion which is in a way considered positive, as it is possible to reach many steps despite overweight. Using pedometers is held as a good way to measure physical activity (St ahle 2010). They are simple to use and understand, but there are also some negative aspects. For example, it does not register activities in water or © 2015 John Wiley & Sons Ltd

Journal of Applied Research in Intellectual Disabilities

activities performed with the upper limbs. The season (winter) in which the measurements were taken for this study could have had an impact on the results, but it was equal for all groups. In the light of the results, it would have been interesting to also know about Saturdays; however, the study design was restricted to only one of the weekend days. The loss of data was probably held to a minimum because of the text messages that were sent to the participants every day, as well as the good communication with the school and accommodation staff for the participants with intellectual disability. The loss of data was also less because of the availability of the test leaders who, in a short amount of time, were able to replace a broken or lost pedometer. There was a difference in settings that the intellectual disability group live in managed housing accommodation and the non-intellectual disability group live with their families which may have influenced the results but was not controlled for. As this was part of a larger study, the present authors did not calculate power on number of steps a priori. Using the given effect size in this study, the statistical power was determined to 46%. That given, this study gives only an indication of the present situation with regards to the number of steps taken. However, fairly representative as participants with intellectual disability were a convenience sample that had the possibility of being representative of the national intellectual disability population due to the fact that they were part of a standard educational arrangement for these students. The sample without intellectual disability was also a convenience sample whose representativeness was assumed based on the fact that their area of origin was a typical Swedish town. The present authors believe that participants with intellectual disability who receive a good foundation of physical activity in school will possibly maintain a higher physical activity level in their adult lives. This could also be of importance to prevent some of the related diseases that are common among the adult population with intellectual disability (Nilsson 2010). However, there has to be longitudinal studies to confirm that idea and pedometers could be used for the evaluation.

Acknowledgments The present authors appreciate the participation from the adolescents and young adults and also other persons involved in this study. © 2015 John Wiley & Sons Ltd

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Conflict of Interest None.

Correspondence Any correspondence should be directed to Sven Blomqvist, Swedish Development Centre for Disability Sport, Bolln€ as, Sweden (e-mail: [email protected]).

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Tudor-Locke C., Burkett L., Reis J. P., Ainsworth B. E., Macera C. A. & Wilson D. K. (2005) How many days of pedometer monitoring predict weekly physical activity in adults? Preventive Medicine 40, 293–298. Tudor-Locke C., Bassett D. R. Jr, Rutherford W. J., Ainsworth B. E., Chan C. B. & Croteau K. (2008a) BMI-referenced cut points for pedometer-determined steps per day in adults. Journal of Physical Activity & Health 5, 126–139. Tudor-Locke C., Hatano Y., Pangrazi R. P. & Kang M. (2008b) Revisiting “How many steps are enough?”. Medicine & Science in Sports & Exercise 40, 537–543.

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© 2015 John Wiley & Sons Ltd

Physical Activity Levels Among Adolescent and Young Adult Women and Men with and without Intellectual Disability.

As physical activity can prevent overweight and promote general health, the aim was to investigate the amount of physical activity among adolescent an...
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