Physical activity and sedentary behavior assessment among adults with intellectual disability: addressing methodological gaps
Date
2025
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
University of Delaware
Abstract
Adults with intellectual disability face a cascade of health disparities compared to adults without ID. Growing evidence suggests that sufficient physical activity (PA) and limited sedentary behavior (SB) participation can mitigate cardiometabolic risks and improve the cardiorespiratory fitness of adults with intellectual disability. However, for adults with intellectual disability, the quality of evidence as rated by the World Health Organization in 2020 was ‘insufficient’ for determining dose-response relationships between PA, SB, and these health outcomes and ‘limited’ in supporting the relationship between PA, SB, and quality of life and physical functioning levels. More robust efforts are urgently needed to compile sufficient and high-quality evidence and inform optimal population-relevant guidelines. ☐ This dissertation’s objective was to rigorously identify evidence to support a PA and SB assessment methodology for adults with intellectual disability. Guided by a conceptual framework, it included three main aims: (1) identify the existing methodologies for PA and SB assessment among adults with intellectual disability in the free-living setting, (2) examine the compliance with using a novel consumer-grade assessment tool by adults with intellectual disability in the free-living setting, and (3) gain the perspectives of adults with intellectual disability and their caregivers on the factors that impact the independent and sufficient use of a wrist-worn consumer-grade and a wrist-worn research-grade wearable and an adapted activity log for a one-week PA and SB assessment. ☐ The scoping review followed PRISMA guidelines, yielding 91 included articles from the 11 databases searched and 8174 articles subsequently screened by two independent reviewers. Data, extracted in Covidence (v.2.0), included quantified PA and SB volume, assessment methodology characteristics across data collection and analysis, and data sufficiency metrics. Substantial variation existed across studies regarding preparatory actions, such as sampling frequency and epoch length settings, calibration protocols, and wearable placements. Only a few studies provided instructions that did not exclusively rely on spoken language. During data collection, behavioral strategies included self-monitoring, issuing reminders, providing assistance or supervision, and administering questionnaires verbally. Sufficient PA or SB data for analysis ranged from 24.5-100.0% for objective techniques, 0-100% for subjective techniques, and 24.5-100.0% for combined techniques. This review revealed a need for comprehensive and consistent reporting practices, especially with the rapid technological advancements in PA and SB research. ☐ Emergent evidence supports using the market-leading, consumer-grade Apple Watch for valid and reliable PA assessments and integration in PA and SB interventions. However, research on its use among adults with intellectual disability remains limited despite its growing popularity. The descriptive, observational study evaluated the compliance of nine adults with intellectual disability with using the Apple Watch Series 4 for a consecutive seven-day PA assessment. Behavioral strategies to support compliance included daily activity logs and visual activity schedules for putting on, charging, and cleaning the Apple Watch. Researchers met with participants daily to ensure log use. Six (67%) participants met a heart rate-based compliance criterion (‘≥10hrs hourly heart rate’), and seven (78%) met a step-count-based compliance criterion (‘between 1,703-24,369 steps/day’) for at least four days. Log entries were 57% researcher-, 40% self-, and 4% caregiver-written. While compliance with using the Apple Watch was comparable to other research-grade and consumer-grade wearables used for PA assessment by adults with intellectual disability, additional individualized strategies may enhance its use. ☐ To address these gaps, the randomized crossover study examined the factors that impact independent and sufficient use of the ActiGraph GT9X-Link (AG), Apple Watch Series 4 (AW), and adapted activity log by adults with intellectual disability. Guided by the Social Cognitive Theory, individual interviews were conducted after a purposive sample of 12 adults were randomized into using the AG or AW for one week before switching after at least a one-week washout period. Seven participants independently used the AW, four independently used the AG, and two independently used the log during Week 2, while none did so during Week 1. Sufficient use criteria were met by 11 participants for the AW, eight for the AG, and six during Week 1 and 10 during Week 2 for the log. More facilitators than barriers were mentioned for all tools, such as routine establishment and external guidance. Findings suggest that addressing environmental and behavioral barriers could be more effective than focusing solely on personal factors in promoting independent use. Notably, higher cognitive abilities did not consistently relate to greater independence in logging behaviors. More influential may be the log format, its integration into daily routines, and an accessible wearable time-format. Furthermore, younger adults, those with higher daily-living adaptive behavior skills, and those mentioning more personal facilitators displayed more challenges with AG use, suggesting wearable design, particularly physical, interfaces, and interactive attributes, and the perceived benefits were significant for participants. Optimizing tool design and supporting personalized habit and skill formation may reduce the need for external support and enhance sustained use over time. These findings reveal a complex interplay between behavioral, environmental, and personal factors and tool usability, highlighting the importance of personalized strategies for adults with intellectual disability. ☐ High-quality assessment is crucial for all health promotion and disease prevention research phases––from identifying influences on behavior to evaluating interventions to translating research into practice. Overall, this work seeks to guide the development and refinement of assessment tools that not only generate high-quality PA and SB data but also align with participant preferences and diverse support needs, intending to foster self-efficacy throughout the assessment process. By investigating behavioral, environmental, and personal factors, this research sought to inform the design assessment tools and methodologies––particularly preparatory actions, instructions, and behavioral strategies––that are accessible, acceptable, practical, and beneficial for adults with intellectual disability through actionable insights. This process is not a one-size-fits-all approach. Future research is warranted to explore personalized approaches to optimize PA and SB assessment methodologies and tool use, incorporating participant-centered design principles, testing long-term compliance strategies, and expanding these efforts across diverse capabilities and characteristics. This will ensure data quality and foster meaningful participation in health behavior research.
Description
Keywords
Accessibility, Intellectual disability, Mixed methods, Social Cognitive Theory, Wearables