Internet–based exercise for people with intellectual disabilities

People with intellectual disabilities (ID) are less physically active than people without ID and the health aspect for this target group is alarming. Overweight is a common health problem for people with ID, 19-21 percent have obesity and about 44-55 percent are overweight, which is 50 percent more compared to peers without ID(1).

This leads to an increased risk of developing a cardiovascular disease (CVD) or type 2 diabetes. An inactive lifestyle also affects quality of life, which previous studies have shown are ten times worse in people with ID compared with counterparts(2). However, with increased physical activity, promotion of quality of life and prevention of CVD are possible and according to WHO, 75 percent of all CVDs can be prevented by physical activity(3).

Inequities in health

Imagine a world where no one is disadvantage from reaching full health potential because of structural or social inequities. Various factors that may contribute to health inequity in different populations are many, for example community-wide problems such as unemployment, poverty, low educational level, lack of public transportation, exposure to violence, can contribute to health inequities(4).

Barriers to physical activity are influenced by health inequities such as transportation issues, lack of awareness of options and financial limitations and these barriers are more prominent for people with ID(5). Where the rate of CVD is high, the education level is low, the sedentary lifestyle is high, and people have unhealthy diet and are smokers.

The barriers are many

The health literacy for people with lower education are also low in which health literacy may be an explanation in the relationship between poor health and low level of education(6). Low health literacy skills may be a barrier to access health information, disease prevention and health care. The World Health Organization recognizes disabilities as a global public health issue, one of the objectives in the global action plan is to remove barriers and improve accessibility to health services(7).

Exercise interventions for people with ID show promising results, however, the ability to maintain the training routines after an intervention period display less promising results. During an intervention, everything is included. Participants do not need to pay for access to training, transport issues are solved, and they are supported from staff.

Consequently, the barriers explained earlier are not present. However, when finishing a project period, financial limitations, transport issues are present again. Solutions that limiting the barriers and enhances possibilities needs to be investigated.

Innovative solutions

Most of the research on exercise for people with ID have been done in a lab gym or similar. This often requires travel and a lot of planning. However, some innovative solutions have been explored. For example, smartphone reminders for physical activity and education in health for the target group. Although, as far as we know, no previous studies have examined internet-based training for the target group, which would limit some of the barriers to training and thus a more accessible way to be physically active.

From science ...

Between September and December 2020, a study was conducted in Region Jämtland-Härjedalen, to increase physical activity and improve health for people with ID. Four out of eight municipalities in the region participated, a total of 27 citizen with ID.

For 12 weeks, an internet-based training program were provided, adapted for people with ID. Participants performed the training three times a week, á 50 min, according to WHOs recommendations for physical activity.

This, rather easy conducted study, generated in an attendance rate of 85 percent, a significant decrease in fat mass for the participants and a willingness to be physically active. Moreover, the waist circumference decreased significantly, and participants reported better sleep habits and less sedentary time.

... to practice

As mention above, if the research findings of this study are not taking care of, probably, the participants would go on with their life as before the study started, with more sedentary time, difficulties in sleep and a growing overweight.

However, this is a great example when going from science to practice. The health team in the biggest municipally in the region were provided information about the project and now, in March 2021, this kind of exercise is about to be implemented in the daily activities for people with ID.

An observation from the study and a key to success, is to have baseline measurements and follow up measurement, why the health team will include that in the continuous work. In the pilot study, four residential homes were included from this municipality, for the following development project, 92 residential homes will be included.

This will not change the health dramatically for people with ID, but it is towards the right direction for a more accessible way to be physically active and thus less inequities in health.

Referenser

1. Bhaumik S, Watson JM, Thorp CF, Tyrer F, McGrother CW. Body mass index in adults with intellectual disability: distribution, associations and service implications: a population-based prevalence study. J Intellect Disabil Res. 2008;52(Pt 4):287-98.
2. World Health Organization. The World health report 2000 : health systems : improving performance. Geneva; 2000.
3. Elinder LS, Bergstrom H, Hagberg J, Wihlman U, Hagstromer M. Promoting a healthy diet and physical activity in adults with intellectual disabilities living in community residences: design and evaluation of a cluster-randomized intervention. BMC Public Health. 2010;10:761.
4. Baciu A, Negussie Y, Geller A, Weinstein JN. Communities in Action: Pathways to Health Equity. In: Baciu A, Negussie Y, Geller A, Weinstein JN, editors. Communities in Action: Pathways to Health Equity. Washington (DC)2017.
5. Bodde AE, Seo DC. A review of social and environmental barriers to physical activity for adults with intellectual disabilities. Disabil Health J. 2009;2(2):57-66.
6. van der Heide I, Wang J, Droomers M, Spreeuwenberg P, Rademakers J, Uiters E. The relationship between health, education, and health literacy: results from the Dutch Adult Literacy and Life Skills Survey. J Health Commun. 2013;18 Suppl 1:172-84.
7. World Health O. Global action plan on physical activity 2018–2030: more active people for a healthier world. Geneva: World Health Organization; 2018 2018.