Jeff Walkley

Perspectives of Constraining and Enabling Factors for Health-Promoting Physical Activity by Adults with Intellectual Disability.

Abstract Background Physical activity influences health in individuals and within populations. This study explored factors perceived as enabling or inhibiting participation in physical activity by adults with intellectual disability from a health promotion perspective. Method Six focus group interviews were conducted: adults with intellectual disability (1 group, n = 9), direct care workers (1 group, n = 5), group home supervisors (2 groups, n = 9 and n = 6), managers (1 group, n = 4), and parents (1 group, n = 7). Results Three major themes were identified from the focus group interviews: motivation for participation, social support, and political and financial support. Conclusions The most critical issue was the lack of clear policies. Both day training centres and accommodation services would benefit from development of policies related to health‐promoting physical activity. Flowing on logically from the development of policy would be much needed training and support of staff.

Physical activity levels of individuals living in a group home

This study investigated the physical activity patterns of six adults living in a group home. Physical activity was measured by direct observation. Participants were observed for seven consecutive days for a total time of 564 hours and 13 minutes. Energy expenditure estimates were calculated from direct observation and Caltrac® accelerometer data. The intraclass correlation between energy expenditure estimates was. 83. On average per day, participants spent 10 hours lying down, 6 hours sitting, 3 hours standing, 3 hours undertaking personal tasks, and engaged in light to moderate sport, leisure or work at other times. Two participants met the Australian guidelines for physical activity participation; another met the guidelines when he was well. Walking for transport was found to offer a simple, cost neutral opportunity for each participant to meet physical activity guidelines if they could be trained to walk faster.

Energy expended by adults with and without intellectual disabilities during activities of daily living

The aims of this study were to (1) determine the energy expenditure of adults with and without intellectual disabilities during common activities of daily living (ADL), (2) use these values to evaluate the accuracy of equivalent activity values reported in the Compendium of Physical Activities (CPA), and (3) identify ADL that may confer a health benefit for adults with intellectual disabilities when undertaken regularly. Energy expenditure was measured for adults with intellectual disabilities (N=31; 29.0±8.6 yr) and adults without intellectual disabilities (N=15; 30.4±9.6 yr) while undertaking each of seven ADL: sitting quietly (SitQ); sitting watching television (SitTV); sitting and standing while completing an assembly task (SitAT, StaAT); and walking at a slow (WalkS, 3.0 km h(-1)), quick (WalkQ, 6.0 km h(-1)) and fast (WalkF, 9.0 km h(-1)) speed, under laboratory conditions. Adults with intellectual disabilities were found to expend significantly more energy than adults without intellectual disabilities for SitQ, WalkS, WalkQ and WalkF (p<0.05). Energy expended by both populations was significantly more than CPA values for SitQ, SitTV, SitAT, WalkS, and WalkQ (p<0.02) and significantly less for WalkF (p<0.01). Walking at the speed of 3.0 km h(-1) (50 m min(-1)) was found to be sufficient to achieve moderate-intensity energy expenditure, surpassing the intensity threshold for conferring a health benefit. Energy expenditure inaccuracies of the CPA have important consequences when estimating prevalence of engagement in health enhancing physical activities among population sub-groups. The identification of slow walking as a moderate-intensity physical activity offers significant health promotion opportunities for adults with intellectual disabilities through active transport and leisure.

Parent- and Adolescent-Reported Barriers to Participation in an Adolescent Overweight and Obesity Intervention

This study explored reported barriers to treatment completion in a sample of adolescents and their parents who either completed or did not complete family‐based cognitive behavioral lifestyle intervention for overweight and obese adolescents. The sample comprises 56 overweight or obese adolescents (52% female) aged 11.5–18.9 years (mean = 14.5, s.d. = 1.8) and a parent. 57% of families did not complete treatment and maintenance phases of the intervention. A telephone‐administered questionnaire assessing barriers to participation was completed by 96% of adolescents and 91% of parent completers and 100% of adolescents and 94% of parent noncompleters. Adolescents and parents most commonly reported barriers to participation related to research demands, treatment approach, program components/strategies, practical barriers, and other individual/family demands. Parents also noted adolescent effort, parent‐adolescent conflict, and adolescent unhappiness as barriers to participation. While both completers and noncompleters experienced barriers to participation, families who discontinued treatment reported experiencing more treatment barriers. Findings of the current study suggest that adolescents and parents may find it easier to participate in adolescent overweight and obesity interventions if research and out‐of‐session program demands are minimized, efforts are made to enhance adolescent motivation, and treatment is offered in a convenient location and scheduled around school holidays and other family demands. Results also suggest that targeting adolescent unhappiness, family stressors, and parent‐adolescent conflict in treatment may improve retention. Future research should explore the impact of these modifications on treatment completion and outcomes.

Day-to-day physical functioning and disability in obese 10- to 13-year-olds

What is already known about this subject? Compared with their healthy‐weight peers, children with obesity have; impaired physical health‐related quality of life reduced physical activity levels reduced capacity to perform certain weight‐bearing tasks in field‐based fitness tests

Body mass index as an indicator of adiposity among adults with intellectual disability

Abstract Background Body mass index (BMI) has been identified as a key health indicator and determinant of health for people with intellectual disability. Our aim was to examine whether BMI is a useful indicator of adiposity among a sample of adults with intellectual disability. Method Participants were 46 ambulatory community-dwelling volunteers with mild to moderate intellectual disability. Age ranged from 19 to 60 years, 25 were male, and 17 had Down syndrome. Soft tissue composition was determined using a dual-energy X-ray absorptiometer (DXA) and height and weight were directly assessed. Results Regression equations revealed that BMI accounted for 68% of the variance in percent body fat and 83% of the variance in total body fat. Partial correlations of BMI with fat and lean masses determined by DXA were r = .91 and r = −.12, respectively. A BMI of ≥ 30 had excellent specificity for obesity, but less than optimal sensitivity. Conclusions BMI appears to be a reasonable indicator of adiposity, although a BMI ≥ 30 may misclassify a proportion of individuals assessed by DXA as obese.

Predicting Treatment Initiation in a Family‐Based Adolescent Overweight and Obesity Intervention

Little is known about factors associated with treatment initiation in overweight and obese adolescents. This study investigated parent‐reported adolescent demographic, adolescent health, and parent motivation factors associated with initiation of a family‐based adolescent overweight and obesity intervention. A telephone survey was completed by 349 parents calling to register their interest in participating in a cognitive behavioral lifestyle intervention for adolescent overweight and obesity. A total of 172 families (49.3%) returned their consent form to initiate treatment. A binomial logistic regression, with predictors entered in three blocks: (i) adolescent demographic (adolescent age, gender, adolescent BMI‐for‐age z‐score, parent BMI); (ii) adolescent health (perceived adolescent physical and mental health, presence of an adolescent physical health problem or mental health problem, medication intake); and (iii) parent motivation (perceived adolescent weight category, concern about adolescent weight, importance of adolescent weight, confidence in adolescent capacity to change weight, priority of adolescent weight loss, discrepancy between adolescent current and ideal weight, previous weight loss attempts), was significant (χ2 (16) = 35.19, P = 0.004) accounting for 12.4–16.5% (95% confidence interval) of treatment initiation variance. Parent‐reported adolescent physical health problem, parent perception of adolescent weight category, parent priority of adolescent weight loss, and parent perception of discrepancy between adolescent current and ideal weight were significant in the model. These findings indicate that data collected at intake are associated with treatment initiation and highlight the role of assessing and enhancing treatment motivation from initial contact.

An initial evaluation of a long-term, sustainable, integrated community-based physical activity program for adults with intellectual disability

Abstract Background Physical activity (PA) programs for adults with intellectual disability (ID) have positive impacts, at least in the short term. No research has been reported on the effect of long-term engagement in PA programs for adults with ID. This paper explores the physical and psychosocial benefits gained by two individuals with mild ID who participated in a long-term PA program. Method Accelerometery was used to collect PA data during the program and for 7-day periods outside of the program. To explore the psychosocial outcomes gained from participating in the program, participants and their caregivers were interviewed about their participation experiences. Results Across time, a decrease in the amount of light activity engaged in during sessions was found, with participants gradually increasing their moderate to vigorous activity. Psychosocial benefits, including meeting new people and gaining social acknowledgement were reported by participants and caregivers. Conclusions Long-term, sustainable, low cost PA programs (such as the one under investigation) can minimise barriers to physical activity for people with ID.

Physiological and behavioural outcomes of a randomised controlled trial of a cognitive behavioural lifestyle intervention for overweight and obese adolescents

AIM This study evaluates the efficacy of the Choose Health program, a family-based cognitive behavioural lifestyle program targeting improved eating and activity habits, in improving body composition, cardiovascular fitness, eating and activity behaviours in overweight and obese adolescents. METHOD The sample comprised 29 male and 34 female overweight (n = 15) or obese (n = 48) adolescents aged 11.5-18.9 years (M = 14.3, SD = 1.9). Participants were randomly allocated to treatment or waitlist control conditions; waitlist condition participants were offered treatment after 6 months. DEXA-derived and anthropometric measures of body composition; laboratory-based cycle ergometer and field-assessed cardiovascular fitness data; objective and self-report physical activity measures; and self-report measures of eating habits and 7-day weighed food diaries were used to assess treatment outcome. Adherence to treatment protocols was high. RESULTS Treatment resulted in significant (p < .05) and sustained improvements in a range of body composition (body fat, percent body fat, lean mass) and anthropometric measures (weight, BMI, BMI-for-age z-score and percentiles). Minimal improvements were seen in cardiovascular fitness. Similar results were obtained in completer and intention-to-treat analysis. Poor adherence to assessment protocols limits conclusions that can be drawn from physical activity and dietary data. CONCLUSIONS Participation in the Choose Health program resulted in significant improvement in body composition. Longer-term follow up is required to determine the durability of intervention effects. Alternative approaches to the measurement of diet and physical activity may be required for adolescents.

Musculoskeletal pain in obese compared with healthy-weight children.

Objectives:To investigate whether obesity is associated with musculoskeletal pain in children. Materials and Methods:Obese (n=107) and healthy-weight (n=132) 10- to 13-year-old children (132 males, 107 females) participated in an observational case-control study. Children self-reported pain location (excluding abdominal pain), pain intensity (current and prior week), and pain prevalence (overall and lower limb) using the Pediatric Pain Questionnaire. Body composition was assessed (dual-energy x-ray absorptiometry) and children wore an accelerometer for 8 days. Results:After adjustment for accelerometry (weekly average counts per hour) and socioeconomic status, obese children had more intense pain (worst pain, P=0.006), pain in more locations (P⩽0.005), and a higher prevalence of lower limb pain (60% vs. 52% respectively, P=0.012) than healthy-weight children. Significant relationships were observed between body mass index and total pain locations (P⩽0.004, unadjusted and adjusted) and worst pain intensity (P⩽0.009, adjusted for socioeconomic status/accelerometry). There were no significant relationships between percent body fat and pain variables (unadjusted/adjusted analyses, P=0.262 to 1.0). Discussion:Obesity in children was associated with increased overall and lower limb musculoskeletal pain, for which body mass index was a stronger predictor than adiposity. Clinicians treating obese children should screen for pain and prescribe exercise programs that take their symptoms into account.