Physical activity levels in older adults with intellectual disabilities are extremely low
Highlights
► 50+ adults with intellectual disabilities have very low physical activity levels. ► Low physical activity levels are seen across the entire 50+ population with ID. ► Only the functionally more able 50+ adults with ID could be measured with pedometers.
Introduction
Although the life expectancy of people with intellectual disabilities (ID) is increasing due to improved health care (Patja, Iivanainen, Vesala, Oksanen, & Ruoppila, 2000), it is unknown whether these extra years are healthy or unhealthy, and prevention in this group has received little attention. Low levels of physical activity have been consistently demonstrated in adolescents and adults with ID (Temple, Frey, & Stanish, 2006). Prevention research has shown the positive effects of physical activity on physical and psychological health (DHHS, 2008, WHO, 2003, WHO, 2009) and such effects are also seen in the ageing population (Chodzko-Zajko et al., 2009, DiPietro, 2001). Considering these health benefits, the World Health Organisation's (WHO) recommendation concerning physical activity is equally as important to vulnerable populations with chronic illness and disability, such as intellectual disability (ID) (Tudor-Locke, Hart, & Washington, 2009). Because older populations are generally less active than younger adults (Caspersen and Merritt, 1995, Chodzko-Zajko et al., 2009), we expect older adults with ID to be at particular risk for low levels of physical activity. In addition to the personal health and wellbeing of older adults with ID, the consequences of inactivity may increasingly influence required levels of support and future health care costs of this population. Therefore, more insight into their physical activity levels is urgently required; this is the first aim of the present study.
Relevant subgroups at risk for low levels of physical activity have been identified in the general population, based on demographic and biological factors. A positive relationship was shown between physical activity and education level, heredity and income; and a negative relationship between physical activity and older age, female gender and race (non-white) (Trost, Owen, Bauman, Sallis, & Brown, 2002). In the population with ID, negative relationships have repeatedly been found for older age (Finlayson et al., 2009, Peterson et al., 2008), more severe level of ID (Peterson et al., 2008), epilepsy (Finlayson et al., 2009), and living in more supported settings (Finlayson et al., 2009, Robertson et al., 2000) or, contradictorily, living in a group home (Rimmer, Braddock, & Marks, 1995); whereas, in contrast with the general population, no difference in physical activity levels was found between men and women (Draheim et al., 2002, Peterson et al., 2008, Stanish and Draheim, 2005b), with the exception of one study (Emerson, 2005). Because of such inconsistencies, together with the small number of factors investigated and the inclusion of young/healthy participants with only mild to moderate ID, the second aim of this study was to examine which subgroups are at higher risk of physical inactivity among the older population with ID.
Section snippets
Study design and participants
This study was part of the large cross-sectional study ‘Healthy ageing and intellectual disabilities’ (HA-ID), conducted by a Dutch consortium of three healthcare providers (Abrona at Huis ter Heide; Amarant at Tilburg; and Ipse de Bruggen at Zwammerdam), in collaboration with two university institutes (Intellectual Disability Medicine, Erasmus Medical Center at Rotterdam; and the Center for Human Movement Sciences, University Medical Center at Groningen).
All 2150 clients with ID (aged ≥50
Participation
Of the 1050 participants in the HA-ID study (Hilgenkamp et al., 2011), only 257 (24.5%) had a successful measurement with the pedometer. Fig. 1 shows the progress of participants through study, and data on drop-outs. The main reasons for drop-out were physical disability (n = 103), walking speed <3.2 km/h (n = 252), and limited understanding (n = 38) or non-cooperation of participants (n = 195).
Characteristics of the study population
Chi-square tests revealed significant differences between participants (n = 257) and non-participants (n = 793) in
Discussion
This first study of objectively measured physical activity levels in a near-representative sample of 1,050 older adults with ID, shows that only 257 of the group were able to participate in valid measurements with pedometers. This low number is largely due to physical limitations (n = 103), walking speed <3.2 km/h (n = 252), and limited understanding or non-cooperation (n = 233). Only 16.7% (95% CI 12.2–21.3) of the participants complied with the guideline of 10,000 steps/day, 36.2% (95% CI 30.3–42.1)
Conflict of interest
The authors declare that there are no conflicts of interest.
This study was carried out with the financial support of the ZonMw (grant no. 57000003), with no involvement in recruitment, data collection, analyses and interpretation of data, in writing the article or in submission for publication.
Acknowledgements
The authors thank the participants, their family members and their caregivers for their collaboration. Thanks are also extended to all employees of the care provider organisations who assisted in administering one or more of the study assessments.
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