1 Running head: FITNESS INTERVENTION FOR POPULATIONS WITH INTELLECTUAL DISABILITY A preliminary evaluation of a s ocial c ognitive t heory based structured physical activity program for improving fitness in populations with an intellectual disability Krishn a Dipnarine University of Florida Mentors: Anthony T. Delisle, B.S., M.S., Ph.D. Student Christine B. Stopka, B.S., M.Ed., Ph.D., ATC, LAT, CSCS, CAPE, MTAA Mary Ellen Young, Ph.D., CRC /R
FITNESS INTERVENTION FOR POPULATIONS WITH INTELLECTUAL DISABILITY 2 Abstract BACKGROUND: Populations with an intellectual disabil ity (PID) consistently have signif icantly higher rates of obesity and lower rates of physical activity, cardiorespiratory fitness (CRF) and muscular endurance than populations without an intellectual disability. PURPOSE: To evaluate the efficacy and effec tiveness of a Social Cognitive Theory based (SCT) structured physical activity intervention for PID to increase time spent on health enhancing physical activities, increase CRF increase muscular endurance and decrease percentage of total body fat METHOD S: Thirteen young adults with an intellectual disability (ages 1 7 22, 38.5% female) participat ed in a 1 hour structured physical fitness intervention, held twice a week, for 8 weeks. Physical fitness assessments were conducted pre and post intervention. RE SULTS: On average, heart rate decreased 24.2 % 1 minute post YMCA step test, bench press reps increased 41.7 %, upright seated row reps increased 81.3 %, seconds maintaining static plank form increased 58.4 %, wall pushups reps increased 61. 7 %, and muscle mas s increased from 34.83% to 35.41%. CONCLUSION: Results of this study show that PID who received this SCT based intervention significantly increase d time spent on health enhancing physical activity, increa sed CRF and muscular endurance, and decreased percen tage of total body fat This substantiates the need for exercise programs for this population.
FITNESS INTERVENTION FOR POPULATIONS WITH INTELLECTUAL DISABILITY 3 Introduction and Literature Review Intellectual Disabilities (ID) account for 25% of all disabilities in the population of those diagnosed with any form of a disability according to the United States 2000 Census (Stern, 2003). limitations both in intellectual functioning and in adaptive behavior as expressed in concept ual, Frey, & Stanish 2006 p. 2; American Association on Mental Retardation, 2002, p. 8 ). An individual is considered to have an ID if he or she has an Intellectual Quotient (IQ) less than 70 (Hatton, 2002). Obesity related diseases, such as cardiovascular di sease (CVD), cancer, and stroke are the leading causes of morbidity and mortality in the United States (A merican Heart Association 200 8 ; McGi n nis & Foege 1993). O besity is increasing at ep idemic rates in the general population with more than 72 million adults classified a s obese (Bean Olbrisch, & Stewart 2008). Alarmingly, obesity rates are even greater in populations with an intellectual disability (PID) More than two thirds (66%) of young adults with ID are reported to be either obese or overweight (Yamaki, 2005). Subsequently, PID are at an even greater risk of developing and dying from CVD, cancer, and stroke when compared to populations without an ID (Hill, Gridley, & Cnattingius, 2003; Day Straus, & Shavelle 2005 ; Draheim, 2006). Large prospective cohort studies consistently show that physical ina ctivity and low cardiorespiratory fitness (CRF) are strong and independent predictors of obesity, fatal and nonfatal CVD, cancer, and stroke rates in men and women (Warburton Nicol, & Bredin 2006; Peterson, Magid, & Ross, 2008) Adequ ate levels of physical activity are needed to increase CRF, decrease obesity, and to protect against the development of CVD, cancer, and str oke (Pate Pratt, & Blair 1995 ; Kesaniemi et al., 2001). In 200 2 the U.S. Department of Health and
FITNESS INTERVENTION FOR POPULATIONS WITH INTELLECTUAL DISABILITY 4 Human Services (DHHS) released physical activity guidelines calling for an hour of moderate to vigorous physical activity on five or more days a week for young adults ( U.S. DHHS, 2002) National surveillance data and recent research estimates that less than 15% of PID meet these guidelines, compared to 33% of people without ID ( Eaton et al., 2008 Pate Long, & Heath, 1994; Pate, Freedson, & Sallis, 2002 ; Faison Hodge & Porretta, 2004). The effectiveness of improving CRF through physical activity in PID is poorly understood. Unfortunately, few prospective studies have examined the relationship between physical activity, CRF obesity, and health outcomes in young adults with ID. However, researchers hypothesize PID will increase CRF in the same manner as th e general population with adequate levels of health enhancing physical activity. Theory of social cognitive functioning Social C og nitive T heory (SCT) posits that behavior changes may occur from setting personal goals based on the outcomes of these goals and the tasks and self efficacy expectations needed to achieve these goals (Heller Hsieh, & Rimmer 2004 ; Bandura, 1977 & 1986). In accordance with this theory, i ndividuals are more inclined to change their habits if they believe that (a) they are appropriately reinforced to perform a behavior (b) they observe the desired behavior and desired consequences that accompany the behavior (c) they possess the behavioral capability to perform the desired behavior and (d) they possess the confidence to successfully perform the desired behaviors (self efficacy expectations) (Heller et al. 2004). SCT is demonstrating the most promise for eff ectively intervening on the social, environmental, and institutional policy levels (Booth Owen, Bauman, Clavisi, & Leslie 2000). SCT rationalizes that social factors, such as peer influences, role modeling of behaviors, and vicarious learning are signifi cant mechanisms involved in physical activity behaviors (Booth et al. 200 0 ).
FITNESS INTERVENTION FOR POPULATIONS WITH INTELLECTUAL DISABILITY 5 Increasing P hysical Activity in PID through Adapted Physical Education Physical education (PE) classes in the school based setting have been the focus of efforts to increase ph ysical activity levels in youths and adolescents. Over 82% of school districts require schools to mainstream students with disabilities into regular PE classes (Burgeson Wechsler, Brener, Young, Spain 2001). However, students with ID often do not parti cipate in health enhancing physical activity behaviors during PE classes due to a number of barriers These barriers include disability lack of qualified adapted physical educators h igh student to teacher ratio s which often preclude effect ive ada pted PE efforts and the lack of resources necessary to engage students with ID in health enhancing physical activity behaviors in the traditional PE setting (Ay v azoglu Ratliffe, & Kozub 2004). This exemplifies the need of adapted PE for PID. Ada pted PE activities, games, sports, and rhythmical movements suited to the interests, capabilities, and French, Candler, Fr ench, & Hamilton, 2007). The barriers mentioned above undermine the ability of PID to meet the recommended levels of physical activity set by DHHS, as well as the ability to meet national PE standards for all children set by the National Asso ciation for Sport and Physical Education (Ayvazoglu et al. 2004). School health officials are calling for urgent action to address the issue of physical inactivity and obesity in PID. For PID, the SCT approach to intervention may result in the reduction of the internal and external barriers to physical activity mentioned earlier. Research is needed to inform the feasibility of developing and implementing innovative interve ntions to promote health enhancing physical activity increase CRF, decrease obesit y, and to prevent the development of chronic disease in PID
FITNESS INTERVENTION FOR POPULATIONS WITH INTELLECTUAL DISABILITY 6 Research Question/Hypothesis It is hypothesized that young adult s with an ID who receive a n 8 week peer guided, SCT based structured physical fitness intervention will significantly increase tim e spent on health enhancing physical activities, increase cardiorespiratory fitness, increase muscular endurance and decrease percentage of total body fat when compared to pre intervention measures. This research aims to gain an understanding of SCT based physical activity interventions as they pertain to PID to develop and implement effective and efficient programs. Methods Participants. The participants in this study include d 13 young adults (ages 1 7 22, 38.5% female) with either mild (55
FITNESS INTERVENTION FOR POPULATIONS WITH INTELLECTUAL DISABILITY 7 for each workout, and motivate the participant to achieve better results each time si nce motivation and understanding the movement is a major barrier to proper performance. Data analysis Pre and post test ing on a variety of physical fitness measures were taken immediately prior to and following implementati on of the fitness intervention These include d a YMCA cardiorespiratory fitness test six muscular endurance a ssessments (using the same weights pre and post) and four body composition measures as well as demographic information All testing was administered by trained research assistan ts. Intra rater reliability testing was conducted to assess the accuracy and consistency of measures taken from each research assistant performing the physical fitness testing. The data was analyzed using a dependent paired samples t test to determine any differences b etween pre and post intervention measures The traditional level of significance (alpha = 0.05) was used to detect statistical significance. Results A paired samples t test revealed that there were statistically significant differences b etween pre and post measures in the following results. The average heart rate 1 minute after the YMCA 3 minute step test was 24.2% lower after the 8 week training program ( M = 113.77 7.87 bpm ) compared to before the program ( M = 150.15 22.76 bpm ), t (12 ) = 7.300 p <0 .001 with a relatively large effect size ( r = 0. 90 ) The average leg extension repetitions doubled from M = 11.69 4.17 to M = 22.38 11.39 t (12) = 3.265 p= 0.007 Average b ench press repetitions significantly increased by 41.7 %, from M = 10.69 2.93 to M = 15.15 5.58 with t (12) = 2.761 p = 0 .017. Average upright seated row repetitions significantly increased by 81.3 % from M = 14.85 4.16 to M = 26.92 14.07 with t (12) = 3.168 p = 0.008 The average time that each participant maintained proper form in a static plank significantly increased by 58.4 % from M = 43.23 29.29 seconds to M = 68.49 45.72 seconds with t (12) = 2.246 p =
FITNESS INTERVENTION FOR POPULATIONS WITH INTELLECTUAL DISABILITY 8 0.044. The average number of wall pushups significantly increased by 61.7 % from M = 12.78 2.82 to M = 20.67 9.04 with t (8) = 2.399, p = 0.043. The remaining results are not statistically significant but they show a change on average between pre and post intervention measures. Average percent body fat decreased from M = 26.6 7 % to M = 26.55%. Average muscle mass percent increased from 34.83% to 35.41%. The average leg curl repetitions increased from M = 14.92 to M = 18.46. Average weight increased from M = 155.94 lbs to M = 156.55 lbs Average body mass index remained similar between baseline and post measures (from pre M = 26.52 kg/m to post M = 26.81 kg/m ). Waist circumference differed slightly from pre M = 33.19 inches to post M = 34.85 inches After accounting for an outlier, the average maximum time for w all sits increased from M = 39. 92 seconds to M = 47.75 seconds The average number of shooting stars (in which the participant squatted and jumped to reach a height as many times as possible in 30 seconds) remained very similar, with pre M = 11.50 and post M = 11.75. The average numbe r of mountain climbers (in which participants were in an extended push up position and alternated flexing their legs to their mid section and extending back to original position to simulate climbing and work ing the leg muscles) increased from M = 18.36 to M = 22.36. Discussion The results of this study support ed the hypothesis that young adults with an ID who receive d an 8 week structured physical fitness intervention would significantly increase time spent on health enhancing physical activities, increas e CRF and increase muscular endurance when compared to pre intervention measures. There was a decrease in percentage of total body fat though it was not statistically significant The decrease in heart rate 1 minute post YMCA step test indicates that the
FITNESS INTERVENTION FOR POPULATIONS WITH INTELLECTUAL DISABILITY 9 compared to pre intervention measures. This is an indicator of improved CRF. The participants of this study were engaged in endurance training through weight machines and functional training exercises, as well as recreational sports which involve d continuous participation in activities that increase d cardio vascular workout. The train ers also le d the participant s through various personalized exercises and activities between pre and p ost testing according to the social relations with their trainers, and interacted with each other better compared to pre intervention observations. This social interaction seems to have motivated the participants to engage in physical activity as the participants seemed to be more open to instruction and participation. All of this together may account for the results obtained. Limitations of this study include t he small sample size ( N = 13) and there was not a control group, though there w as a comparison group of the UF student volunteers, which is analyzed in a separate study. Conclusion T he results of this study show strong support for the physical benefits o f a health enhancing, peer guided SCT based health intervention program as seen in the significant improvement in fitness measures. This peer guided approach reduces the barrier of high student to teacher ratios which often preclude effective adapted phy sical education efforts as well as the lack of resources necessary to engage students with ID in health enhancing physical activity in a tr aditional PE setting. Further research is needed to investigate the psychosocial benefits of this type of pr ogram, t he benefits of using personalized training programs between pre and post measures and the efficacy and efficiency of implementing this program structure in diverse i nstitutions and fitness centers as a precursor to future programs of this type to benefit p ersons with intellectual disabilities on a global scale.
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