Fitness for Elders With Intellectual Disabilities: A Health Promotion Demonstration Project
by Tamar Heller & Beth Marks
Although we know the health benefits and increased longevity that result
from moderate to vigorous physical activity and exercise, adults with intellectual
disabilities rarely participate in exercise programs. This population's risk
of developing secondary conditions associated with inactivity is particularly
high given their sedentary lifestyle and high use of anti-epileptic medication--as
well as the earlier appearance of age-related physical changes for some groups,
such those with Down's syndrome or cerebral palsy.
Researcher James Rimmer and his colleagues at the University of Illinois at Chicago (UIC) have found that obesity and cholesterol levels are higher for this population than for the general population. This is particularly the case for women and for adults in independent living settings. Among adults with Down's syndrome, nearly half of the women and nearly one third of the men had morbid obesity. Findings from the National Medical Expenditure Survey of 1987 indicate that older adults with intellectual disabilities living at home exercised less frequently than other older adults. In addition to producing negative health effects, these factors can create barriers to successful employment, participation in leisure activities and performance of daily living activities.
Collaborating Research Centers
Three research centers at the University of Illinois at Chicago have jointly developed a health promotion demonstration and research program for middle-aged and older adults with developmental disabilities. Collaborators are the Center on Health Promotion (CHP) Research for Persons with Disabilities, funded by the Centers for Disease Control and Prevention; the Rehabilitation Research and Training Center (RRTC) on Aging With Developmental Disabilities, funded by the National Institute on Disability and Rehabilitation Research; and the Roybal Center on Health Maintenance, funded by the National Institute on Aging.
The 12-week center-based program, which meets three days per week, involves exercise, nutrition classes and health behavior education. It also includes a caregiver education program. Goals are to increase the physical functioning of the participants, increase their knowledge of healthy behaviors, and help facilitate social and environmental supports for exercise adherence after the training ends. rrtc director Tamar Heller and CHP director James Rimmer are leading a five-year research initiative to examine the efficacy of this physical exercise and education program and to develop models for predicting this population's long-term adherence to enhanced levels of physical activity. Following are the basic elements of the program:
Center-Based Fitness Intervention. The exercise program includes an hour a day of physical activity three days a week. Activities are designed to increase muscle strength, improve cardiovascular fitness, and enhance flexibility. The exercise modalities vary according to the preferences of the participant.
Education for Adults With Intellectual Disabilities. The health education component is designed to help the participant understand the benefits of health promotion behaviors in general and for themselves personally; develop health promotion goals and action plans based on personal preferences; teach participants about healthful foods and how to prepare nutritious meals; and increase participants' self-efficacy in making choices and in attaining personal goals.
With a maximum of nine participants, these sessions are taught once a week for 12 weeks in the hour before the exercise begins. The trainers foster social contact among the participants by encouraging exercise and leisure activities outside of the center. At the end of the training, participants receive a personal written plan that they develop during the program; this includes their exercise goals and the steps they need to take to attain them.
Caregiver Education. The caregiver education program seeks to motivate primary support people--a family member or residential provider--to help participants set health promotion goals, develop action plans and attain their goals. It also includes information about the benefits of exercise, the specific exercise program tailored to the needs of the individual, and ways to monitor physical activity jointly with the individual. This monitoring activity is intended to reinforce perceptions of exercise efficacy.
The education program is held for two hours every other week for a total of six sessions. The sessions take place during the same time that the individuals with intellectual disabilities receive their education and exercise intervention. The individual with intellectual disabilities takes part in three of the sessions. An outcome of this program is the rrtc's Exercise and Nutrition Health Education Curriculum for Adults with Developmental Disabilities, a program that assists others in implementing this innovative approach to health promotion.
Research Program. The research uses a randomized pretest- posttest control group design to determine the effectiveness of the health promotion intervention model. Adults ages 30 years and older with mild to moderate intellectual disabilities are randomly assigned to one of the three groups with varying levels of intervention: control; exercise and education; or exercise, education and caregiver education. Participant outcomes are assessed after the program at four intervals of six months each using measures of exercise adherence, physiological functioning adaptive functioning, and psychosocial functioning of the adult with intellectual disabilities. The project has developed and validated a battery of new instruments to assess social and cognitive aspects of exercise adherence for adults with cognitive impairments.
To date, this project has assessed 62 subjects including 22 individuals who have completed the exercise and education program. Results of pre- and posttesting with these 22 participants show significant improvements in exercise knowledge, life satisfaction and confidence in their ability to perform exercise. Findings indicate participants have significantly improved their fitness based on measures such as strength, flexibility and cardiovascular fitness.
The project also has produced some initial data on social-environmental and cognitive factors promoting exercise adherence among adults with intellectual disabilities. The key barriers to exercise were cost, being tired or bored by the exercise, and problems using equipment. Over two-thirds of the individuals reported receiving little support for engaging in exercise, with no one telling them or showing them how to exercise, and no one paying for an exercise program for them. About half of the individuals lacked confidence in their ability to perform exercises, particularly those involving weights and machines.
When caregivers perceived greater benefits of exercise and when there were fewer access barriers to exercise facilities and equipment, adults with intellectual disabilities were likely to exercise more frequently. Preliminary results thus point to a need to improve access to exercise facilities and equipment and to inform and educate caregivers about the benefits and importance of exercise for adults with intellectual disabilities.
Tamar Heller is a professor and director of the Rehabilitation Research and Training Center on Aging With Developmental Disabilities, University of Illinois at Chicago. Beth Marks is a research specialist at the center.
