Jacques Mikulovic

Prevalence of overweight in adolescents with intellectual deficiency. Differences in socio-educative context, physical activity and dietary habits §

The study investigates the prevalence of overweight and obesity in a population of intellectually disabled (ID) adolescents. An observational study was conducted on a group of 410 ID children, living in France. Overweight and obesity, defined according to international standards, were analyzed and related to demographic and sociological parameters, educational care, physical activity and dietary habits. The study highlighted a high prevalence of overweight and obesity (19.0%) in ID adolescents and 22.5% in oldest teenagers, age 15-20 y. This observation was more likely in medico-educative institutes (25.1%) than in general schools (12.3%). Average time spent in physical activity was 4.5 h/week, compared with 3.5 h/week in obese subjects. Time spent in sedentary behavior was 26.6 h/week for the whole population, compared with 18.6 h/week in obese adolescents. Meals were ingested regularly, and adherence to eating breakfast was good. However, snacks and soft drinks were consumed between and during meals by 66.5% of subjects. Overweight in young ID appeared to be related to parental overweight. Even though ID adolescents receive a balanced diet and practice sport regularly, they exhibit a high prevalence for overweight and obesity. In subjects more than 15 years of age, enrollment in medico-educative institutes and parental overweight were contributory factors to poor weight status.

Overweight in intellectually-disabled population: physical, behavioral and psychological characteristics.

Intellectually disabled (ID) people are at high risk of overweight and obesity. Prevalence and risk factors were assessed in a French population of ID adults attending specialized institutions, using a questionnaire focusing on demographic characteristics, physical activities, food habits and self-awareness about body and health. Data analysis included descriptive statistics, univariate and multivariate regression. Overall, 570 participants were included in the analysis (59% male), aged 19-59 years. The mean body mass index (BMI) was 24.9 kg/m(2); 45.6% of participants were overweight (BMI ≥ 25), including 17.2% who were obese (BMI ≥ 30). Participants practiced sports for 5.7h/week on average and were sedentary for 21.8h/week (time spent in front of some kind of screen). Most participants had food and self-care habits usually regarded as healthy. Eighty percent of them felt unhappy with their body and their physical capacities, but otherwise expressed a rather good opinion of themselves. Bivariate and multivariate analyses showed that some behavioral habits were associated with a reduced incidence of overweight and/or obesity, such as regular sport practice outside the institution, good personal body care or alcohol avoidance. The strongest risk factor was gender. Women were much more at risk than men of being overweight (53.9% versus 39.9%) and obese (28.2% versus 9.5%). Results suggest numerous ways to improve the health of institutionalized ID adults, related to sports education, nutrition and self-care, with particular attention paid to women.

Equivalence of accelerometer data for walking and running: treadmill versus on land.

Abstract The aim of this study was to compare equivalence and agreement of physical activity output data collected by a Research Tri-axial accelerometer (R3T) during walking and running on a treadmill versus on land. Fifty healthy volunteers, 35 males (age 21.9 ± 1.8 years) and 15 females (age 21.6 ± 0.7 years), underwent a series of tests on a treadmill and on land with the order of testing administered randomly. Each participant walked for 10 min at 4 km · h−1 and 6 km · h−1, and ran at 8 km · h−1 and 10 km · h−1, with the same accelerometer. Analysis of output data was assessed by two statistical tests: the equivalence test and Bland and Altman method. Mean differences for walking were 41.2 ± 129.8 counts per minute and −68.8 ± 173.15 counts per minute at 4 km · h−1 and km · h−1, respectively. Mean differences for running were 19.1 ± 253.20 counts per minute and 38.9 ± 270.2 counts per minute at 8 km · h−1 and 10 km · h−1, respectively. The physical activity output data from the treadmill were higher by an average of 3.5% than the data collected on land. The differences obtained between the treadmill and on land were small and non-significant. The equivalence test showed that output data from the treadmill versus on land were equivalent (P < 0.05). The Bland and Altman method showed good agreement between the counts obtained on the treadmill and on land (P < 0.05). In conclusion, physical activity output data were similar as measured by the RT3 accelerometer on a treadmill and on land. The findings suggest that the RT3 may be used in a laboratory and extrapolated to data obtained on land.

Physical activity using wrist-worn accelerometers: comparison of dominant and non-dominant wrist.

The purpose of this study was to determine whether there is a difference in physical activity assessment between a wrist‐worn accelerometer at the dominant or non‐dominant arm. The secondary purpose was to assess the concurrent validity of measures of physical activity from the wrist‐worn accelerometer and the waist‐worn accelerometer. Forty adults wore three accelerometers simultaneously, one on the waist and one each on the non‐dominant wrist and dominant wrist, respectively, for 24 consecutive hours of free‐living conditions. Data were uploaded from the monitor to a computer following a 1‐day test period. There were no significant differences in physical activity when comparing the dominant versus the non‐dominant wrist, regardless of axis (P>0·05). Mean daily accelerometer output data from both wrists were strongly correlated with average counts per minute from the ActiGraph worn around the waist (r = 0·88, P<0·001). Findings suggest that the choice to wear the accelerometer on the non‐dominant or dominant wrist has no impact on results. Data from this study contribute to the knowledge of how to best assess physical activity habits.

The CEMHaVi program: control, evaluation, and modification of lifestyles in obese youth.

PURPOSE Obesity in children has increased in recent years. Many studies with differing methodologies have been undertaken to treat obesity. The Control, Evaluation, and Modification of Lifestyles in Obese Youth (CEMHaVi) program is a unique 2-year health-wellness program of physical activity and health education for obese youth. Findings of this study represent results at 1-year follow-up. The purpose of this study was to evaluate the effects of the CEMHaVi program. METHODS Physician-referred subjects (N = 26) participated in the study, 14 girls (13.4 ± 2.9 years) and 12 boys (12.3 ± 2.8 years). Measurements included height, weight, body mass index (BMI), academic performance, sleep habits, and health knowledge. The intervention consisted of a unique program of physical activity, including a variety of games specifically selected to be enjoyable, maintain interest, and motivate subjects to adhere. Activity sessions were offered once per week, 2 hours each session, for 12 months. A health education program was offered once every 3 months for 2 hours per session. Health knowledge, academic performance, self-esteem, and sleep were assessed before and after the intervention. Means were calculated at baseline and following intervention and were compared by paired t tests. RESULTS Findings suggest significant improvements in academic performance (P < .001), quality and quantity of sleep (P < .05), and obesity (P < .05). CONCLUSIONS The program reduced BMI and improved health knowledge, sleep, and academic performance in obese children. The feasibility of a beneficial lifestyle intervention program is encouraging in addressing obesity and related issues in young boys and girls.

A conative educational model for an intervention program in obese youth

BackgroundObesity in children has increased in recent years throughout the world and is associated with adverse health consequences. Early interventions, including appropriate pedagogy strategies, are important for a successful intervention program. The aim of this study was to assess changes in body mass index, the ability to perform sport activities, behavior in the classroom and academic performance following one year of a health-wellness intervention program in obese youth.MethodsThe CEMHaVi program included 37 obese children (19 girls and 18 boys). Participants received an intervention program consisting of physical activity and health education. Assessment included body mass index, academic performance, classroom performance and ability to perform sport activities. Paired t tests were used to assess the effects of intervention, and chi square was used to assess inter-action between measures.ResultsFindings of the study suggest significant decrease in Z scores of Body Mass Index and an improvement of academic performance, classroom behavior and the ability to perform sport activities (p < 0.05). Chi square testing showed significant positive inter-actions between body mass index, classroom behavior and academic performance.ConclusionsResults following year one of CEMHaVi showed that a program of physical activity and health education had positive effects on obesity, behavior in the classroom and the ability to perform sport activities in obese adolescents. Significant inter-action in changes between variables was observed. Findings are important for designing intervention models to improve health in obese youth.

Influence of sleep timing behavior on weight status and activity patterns in adults with intellectual disabilities.

The aim was to explore the relationship between sleep habits and overweight/obesity, physical activity and sedentary behaviors in French adults with intellectual disabilities. This observational study was conducted on 570 French adults with intellectual deficiency. Sleep habits were analyzed and related to anthropometric measures, physical activity and sedentary behaviors. The study was conducted using a self-administered questionnaire. Participants completed the questionnaire during an interview with the principal investigator. Sleep timing behavior was classified into 4 sleep patterns: Early-bed/Early-rise, Early-bed/Late-rise, Late-bed/Late-rise, and Late-bed/Early-rise. Of 570 eligible participants, 61 were excluded because of missing data on age, weight or height. The number of participants identified in each of the four sleep patterns was as follows: Early-bed/Early-rise, N = 119 (23%), Early-bed/Late-rise, N = 171 (34%), Late-bed/Early-rise, N = 100 (20%), Late-bed/Late-rise N = 119 (23%). Participants who wake up earlier are more active than those who rise late (p < 0.02). Participants who slept later spent more time in sedentary activities than those in the Early rise groups (p < 0.01). The number of obese/overweight participants was also higher in Late-bed/Late rise group. Sleep behavior was associated with overweight/obesity, physical activity and sedentary behavior in adults with intellectual deficiency, independently the sleep duration. Implementing intervention or promotion programs on sleep behaviors should be considered in order to meet the objectives of promoting health on anthropometric characteristics and increased physical activity among these disabled adults.

Relationship between sleep habits, anthropometric characteristics and lifestyle habits in adolescents with intellectual disabilities

The aim was to explore the relationship between sleep habits and overweight/obesity, physical activity and sedentary behaviours in French adolescents with intellectual disabilities. This observational study was conducted on 535 French adolescents with intellectual deficiency. Sleep habits were analyzed and related to anthropometric measures, physical activity and sedentary behaviours. The study was conducted using a self-administered questionnaire. Adolescents completed the questionnaire during an interview with the principle investigator. Sleep timing behaviour was classified into 4 sleep patterns: Early-bed/Early-rise, Early-bed/Late-rise, Late-bed/Late-rise, and Late-bed/Early-rise. Of 573 eligible participants, 125 were excluded because of missing data on age, weight or height. The number of participants identified in each of the four sleep patterns was as follows: Early-bed/Early-rise, N=59 (15.4%), Early-bed/Late-rise, N=164 (43%), Late-bed/Early-rise, N=56 (15%), Late-bed/Late-rise N=102 (27%). Adolescents who woke up early were more active than those from the late rise group (p<0.001). The number of adolescents who are sedentary was higher in late rise vs. early rise subjects (p<0.001). Subjects in the late-bed group were more likely overweight and obese (p<0.05). Results suggest that sleep behaviour was associated with overweight/obesity, physical activity and sedentary behaviour in adolescents with intellectual deficiency. Sleep behaviours should be considered in planning health promotion strategies.

Relationship between Tactics and Energy Expenditure According to Level of Experience in Badminton

Research on racket sports has traditionally focused on expert players and has treated energy expenditure and tactics as independent factors. These prior studies could not assess how energy expenditure and tactics changed as a function of experience and skill. Here, the specific relationship between playing tactics and energy expenditure in badminton were assessed. Participants were classified into five stages of badminton experience on the basis of conative criteria: structural (physical abilities), technical (technical skills), and functional (tactics). The physical activity of 99 players (47 beginners, 15 intermediates, 30 advanced, and 7 experts) was measured using a three-axis accelerometer during a badminton set (21 points, no extra scoring). The results showed that physical activity (counts/sec.) ranged between about 115 (Stage 1) and 155 (Stage 5), and differed significantly across the conative stages. For Stages 2 and 4, defined by an increase in use of tactics, physical activity increased substantially. For Stage 3, defined by a decrease in use of tactics, physical activity decreased significantly. Thus, tactically-oriented play appears to be closely related to physical activity.

Social and professional reintegration of the long-term unemployed disabled. Intervention on the body through adapted physical activities, conative teaching skills and social re-energization.

The reintegration of unemployed disabled people is of great relevance not only in France, but also in the rest of the world. This research exclusively concerns French integration plans. These plans are based on a legislative and financing method which is specific to the history of France, both in its definition of handicap and taking care of the disabled. However, experiences bring elements of reflection that could get methods of intervention under way, taking the legislative, social and societal characteristics of any other country into account. The originality of the use of adapted physical activities (APA) in this research remains a recommendation that is easily transferrable in order to achieve better results as far as integration is concerned. Our research is based on training actions intended for an audience of the long-term unemployed disabled. The quality of ‘disabled workers’ is dependent on French administration. In general, people attending these training courses have a physical handicap following a work accident (back or knee problem). The majority of people recognized as ‘disabled workers’ have this type of handicap. However, we followed a paraplegic as well as some people with sensorial deficiencies (blind people). Most of the training programmes proposed to them are centred on qualification. But there is a shortage of professional integration at the end of these training programmes (Roques, 1991, 1993; Demazière, 1992; Robert, 1997). However the number of unemployed ‘disabled workers’ continues to increase despite the efforts being made to take them on (Wuhl 1992; Ravaud and Fardeau, 1993; Pugliese, 1997). In France a law passed in 1987 forces all companies to take on disabled workers to comprise at least 6% of the total workforce, otherwise they are fined. This rate has hardly been reached. This is why there are many efforts to incite and facilitate the employment of these people (Ravaud and Fardeau, 1994). Specific training plans centred on re-energization have been set up, some of them with the planning of a work on the body (Nirje, 1980; Simard et al., 1993).