Sedentary behavior among adults with intellectual disabilities has not been well studied in nursing and other disciplines. A sedentary lifestyle puts adults with and without disabilities at high risk of developing health conditions and diseases. Current literature has revealed few empirical studies on the benefits of reducing sedentary behavior in relation to the health of adults with intellectual disabilities.
This study investigated the factors that helped or hindered the sedentary behaviors of adults with intellectual disabilities. Guided by the socio-ecological model, a critical incident technique was conducted and five adults with intellectual disabilities from the Province of Ontario were interviewed. Adults with intellectual disabilities identified related personal and environmental factors that led to increased sedentary behaviors.
Introduction
Disability can be classified into four types based on the global severity score (Morris et al., 2018). In Canada, there are four severity classes of disabilities: mild, moderate, severe and very severe (Morris et al., 2018). Men with disability were more likely to have mild or moderate disability, while women were more likely to have severe or very severe disability (Morris et al., 2018).
The Sedentary Behavior Research Network defines sedentary behaviors as any arousal behavior characterized by an energy expenditure of one and a half or less metabolic equivalents while sitting or lying down (Tremblay et al., 2017). The Sedentary Behavior Research Network defines physical inactivity as performing insufficient amounts of moderate-to-vigorous intensity physical activity (MVPA), such as not meeting specified physical activity guidelines (Tremblay et al., 2017). . According to Walsh et al. 2018), if adults with ID cannot meet daily activity guidelines due to their condition, they should aim to be active according to their ability to reduce their risk of developing health conditions or diseases.
Literature Review
A systematic review of 19 studies on the sedentary behaviors of adults with ID found that sedentary time ranged from 522–643 min/day (Melville et al., 2017). Sedentary behaviors lead to the development of primary and secondary health conditions in adults with ID (Koyanagi et al., 2018; . Melville et al., 2017). Sedentary behaviors cause a reduction in metabolic activity, resulting in increased risk for cardiovascular issues in adults with ID (Harris et al., 2018; Harvey et al., 2013).
In their comparative study, Dixon-Ibarra et al. 2013) stated that adults with ID may experience age-related changes during their 50s. According to Melville et al. 2018), adults with ID experience social isolation which causes them to spend long periods in sedentary behavior. A longitudinal investigation of the prevalence of low physical activity and sedentary behaviors in 1618 adults with ID by Hsieh et al.
Theoretical Framework
A systematic investigation by Chastin et al. 2014) that focused on the determinants of sedentary behaviors in older women showed five main themes: (1) physical complaints such as pain; (2) lack of environmental services and incentives;. A cross-sectional study by Koyanagi et al. 2018) that explored the correlates of sedentary behaviors in the older adult population suggested that in addition to individual factors, social, environmental, and political factors influenced sedentary behaviors. The socio-ecological model defined four different settings in which sedentary behaviors can occur: home, occupation, transport and leisure (Melville et al., 2017).
Therefore, sedentary behavior can be examined within four specific domains: (1) watching television, (2) engaging in other screen-oriented behaviors in household environments, such as using a computer or mobile phone, (3) sitting in the living room. Through the social-ecological model, a multi-level framework is used to search for determinants for each domain, from the individual level to the society level, in both the population with general and intellectual disabilities (Melville et al., 2017). According to Oviedo et al. 2017), adults with intellectual disabilities showed low participation in physical activity programs due to financial difficulties, lack of support from their caregivers or the struggle to find support staff who can train them.
Methodology
According to Butterfield et al. 2009), researchers using CIT can begin the study by stating their assumptions about the research question. Data in the CIT methodology are collected as words that describe participants' views and beliefs (Bott & Tourish, 2016; Butterfield et al., 2009). No specific sample size is required in CIT compared to other qualitative research methodologies (Butterfield et al., 2009; Viergever, 2019).
In CIT, small sample size recruitment may be sufficient given the rapid data saturation of the methodology (Butterfield et al., 2009; Clark et al., 2018; Flanagan, 1954). Purposive sampling was used to represent the population and provide insight into a specific experience (Clark et al., 2018). To maintain confidentiality and reduce bias, data were anonymized and pseudonyms were assigned (Dixon-Ibarra et al., 2018; Flanagan, 1954; Persolja, 2020).
All devices that were used for data collection were used with the consent and approval of the participants (Dixon-Ibarra et al., 2018). Other considerations included creating readable format documents that explained and described the study and interview process for adults with ID (Butterfield et al., 2009; Dixon-Ibarra et al., 2018; Flanagan, 1954). Written informed consent was obtained from participants prior to conducting or audio recording the interviews (Dixon-Ibarra et al., 2018).
Reliability checks consist of: (1) intercepting the interviews, (2) increasing fidelity by creating an interview guide, (3) independent elicitation by another person, (4) exhausting the data and keeping a log of each interview, (5) reporting levels of participation for each incident, (6) forming categories by an independent person, (7) checking the categories by participants, (8) seeking expert opinions, and (9) using a the theoretical framework that supports the researcher's assumptions (Butterfield et al., 2005; Butterfield et al., 2009; Flanagan, 1954). Applying nine reliability checks helps to either limit researcher biases or make them transparent to the reader (Butterfield et al., 2009; . Flanagan, 1954; Viergever, 2019). According to Butterfield et al. 2009), interpreting and analyzing data in CIT involves three main stages: (1) defining the frame of reference, (2) forming categories using inductive reasoning, and (3) identifying the general level of the reported data.
When necessary, the researcher decided to merge small categories or to break down large categories into smaller ones (Butterfield et al., 2009; Viergever, 2019).
Results
Furthermore, due to obesity, some participants chose to stay at home and not engage in physical activity in the community as they feel constantly tired throughout the day. Environmentally related incidents are considered external events that helped increase the sedentary behaviors of adults with ID in this study. Financial hardship was another environmental incident identified by several participants that prompted them to become more sedentary.
With the intention of reducing sedentary behavior, some participants stated that they tried to participate in physical activities indoors. Some participants reported using sensory aids to reduce stress or anxiety levels when going outside in the community. Some participants believe that offering small prizes for participating in physical activity programs can help them and other adults with intellectual disabilities reduce their sedentary lifestyle.
Running specialized programs for adults with ID that focus on physical activity, such as joining a community club or an aerobic exercise program, was also suggested by some participants. Some participants suggested that awareness and education are two options for becoming less sedentary. Participants suggested offering online education for adults with ID on how sedentary behavior affects health and well-being.
Some participants also recommended that education should include people without ID, especially those working with adults with ID. For example, educating and teaching health care providers and staff working with adults with ID approaches on how to provide advice and ideas for becoming less sedentary. Some participants suggested offering accessible gyms that allow adults with ID to exercise safely without judgment or ability.
Some participants believe that money is the solution to many obstacles to becoming less sedentary.
Discussion
All of the aforementioned activities of daily living contributed to increased sedentary behaviors of adults with ID. These recommendations will help develop programs and activities that decrease sedentary behaviors for adults with ID. The topic of sedentary behaviors of adults with ID is relatively new; Thus, few research studies have been done before.
The process of recruiting adults with ID was difficult as it went through several organizations. Therefore, only a selective group of adults with ID could participate in the study. The incidence of sedentary behavior among adults with ID is likely to vary by province of residence.
The use of triangulation can clarify the what-and-why questions about sedentary behavior of adults with ID. The more perspectives are gathered, the more in-depth understanding about sedentary behavior of adults with ID is gained. Future studies may add accelerometer devices to accurately measure sedentary behavior of adults with ID.
Measurements include counting the heart rate of adults with ID while they engage in sedentary behavior. Thus, it is crucial to combine both objective and subjective data when exploring sedentary behavior in adults with ID. By recognizing these events, several strategies and approaches can be developed to reduce sedentary behavior in adults with ID.
Future studies may investigate these underlying conditions and their effects on increasing sedentary behavior in adults with ID.
Conclusion
Physical activity and physical fitness of adults with intellectual disabilities in group homes in Hong. Qualitative evaluation of a physical activity health promotion program for people with intellectual disabilities in a group home setting. Effects of 12-week combined exercise program on self-efficacy, physical activity level and health-related physical fitness of adults with intellectual disability.
Analysis of the relationship between physical activity and risk factors for metabolic syndrome in adults with intellectual disabilities. A population-based cross-sectional study of the prevalence and correlates of sedentary behavior in adults with intellectual disabilities. Effectiveness of a walking program to support adults with intellectual disabilities to increase physical activity: Walk well cluster-.
Physical activity and sedentary time in active and non-active adults with intellectual disabilities: a comparative study. Multimorbidity and lifestyle factors in adults with intellectual disability: a cross-sectional analysis of a British cohort. A comparison of physical activity, physical fitness, BMI and blood pressure of adults with intellectual disabilities who do and do not participate.
Do you want to participate in this survey or is it OK to say 'no'? Key questions What types of things do you think would be helpful for you to become more active if this was something you wanted.