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CHEER: Research

Project CHEER (Community Health Education and Exercise Resources) is an exciting effort focusing on accessibility of health promotion activities for individuals with varying levels of abilities.

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CHEER Research

This comprehensive literature review included the analysis of over 100 nutrition and physical activity based research journal articles. Of the articles reviewed, approximately 40 articles presented information that related to either intellectual disabilities (ID), hypertension, or both. The first steps of the comprehensive review included identifying pertinent resources and literature that not only related to those with ID, but also hypertension risk. Additional resources reviewed includes; Department of Medicaid, Department of Public Health, UKY Gill Heart Institute, Community Health Inclusion Index, National Core Indicator Data (NCID), CDC, NCHPAD and the Reeves Foundation. Special attention was paid to the NCID to identify specific disparities facing those living in Kentucky with disabilities. Resources were reviewed and categorized by physical activity and nutrition interventions with a secondary review of inclusion strategies. More extensive research has been done in the realm of physical activity related to those with ID compared to nutrition.

This current database as of March 2017 includes; a total of seven online resources were included in the review, 14 physical activity articles, 23 nutrition based articles, and 1 educational presentation. All topics listed in the CHEER database include the findings of one or more published journal articles that can act as guiding materials moving forward. Findings within these topics provide insight on the existing gaps on inclusion strategies for those with ID within the current literature.  As the CHEER project progresses, this database will be continually expanded to encompass extensive resources in all selected topics.

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Several studies have demonstrated that adults with ID have significantly lower rates of physical activity. These studies have also shown that the rates of physical activity vary with level of impairment. Premature aging may be experienced as advanced deconditioning, decreased mobility, decreased coordination and high level of dementia. Barriers may include lack of transportation to programs, limited fitness programs and staffing of individuals who conduct adapted programs. The majority of studies found were done with the DS population. Research has shown improvement in strength, balance, QoL, well being and drop in pain. The research showed positive outcomes for aerobic training, resistance training and balance training. Walking is also recommended as an easy mode of exercise for those with ID. Balance issues are common among adults with ID. It is believed that greater participation and adherence will be seen when a person has the ability to choose the level of their own involvement. Moderate to heavy resistance training may not be necessary because of no direct health or functional benefits. Currently there is a lacking in research examining physical activity for those with ID.

Bartlo, P., & Klein, P. J. (2011). Physical activity benefits and needs in adults with intellectual disabilities: Systematic review of the literature. American Journal on Intellectual and Developmental Disabilities, 116(3), 220-232.

Few studies have been done to look at the combination of physical activity and a health education program on the psychosocial well being of adults with ID. Individuals are more likely to change their exercise behaviors if they believe that their current lifestyle poses a threat to their goals and health, and if exercise can reduce that threat. Research in elderly subjects had shown that participation in exercise lowers levels of depression and increases self-confidence. Topics covered included; attitude toward health, food, exercise, gaining skills about healthy eating and identifying barriers to exercise and healthy eating. Most common barriers reported were lack of energy, boring, too difficulty, no motivation or health concerns. Interventional group in trial experienced more positive outcomes and confidence to perform exercise. There was also a significant difference seen in life satisfaction. Those in the interventional group were more likely to show reductions in levels of depression. 

Heller, T., Hsieh, K., & Rimmer, J. H. (2004). Attitudinal and psychosocial outcomes of a fitness and health education program on adults with Down syndrome. American Journal on Mental Retardation, 109(2), 175-185.

This case study looked at aging individuals and the effects of weight training, cardiovascular training and stretching on overall health. Best results were seen with cardio based exercise, followed by stretching. A low-tech method was said to be the best way to approach the training, so it was least confusing for the participants. Also, a key finding was that different participants found differing length trainings to be more beneficial and enjoyable.

Carter, M. J., McCown, K. M., Forest, S., & Martin, J. (2004). Exercise and fitness for adults with developmental disabilities: Case report of a group intervention. Therapeutic Recreation Journal, 38(1), 72.

This systematic review observed physical activity aerobic based programs for children with disabilities. Positive results were seen in children who participated in running, biking or elliptical based interventions three times a week. These included kids with neuromuscular disabilities and CP. Horseback riding. Much research focused around the topic that when caregivers are involved in the physical activity, and are made aware of the huge benefits that will be seen by the participant, then physical activity levels go up. This should be a main goal, properly informing the caregivers of all the benefits of exercise.

Johnson, C. C. (2009). The benefits of physical activity for youth with developmental disabilities: a systematic review. American Journal of Health Promotion, 23(3), 157-167.

This paper examined three different trials that observed the effects of water based exercise with children who have been diagnosed with CP. In all cases, positive results where seen. These results included; improved flexibility, respiratory function, gait, muscle strength and motor ability. The environment is great for those with painful joints and/or muscles, due to the decreased gravity environment.

Kelly, M., & Darrah, J. (2005). Aquatic exercise for children with cerebral palsy. Developmental Medicine & Child Neurology, 47(12), 838-842.

Approximately 18.7% of the civilian non-instituationalized US population is 2010 has been diagnosed with a disability. People with disabilities who are obese may require more frequent observation, leading to higher healthcare costs. Also, with limited mobility, they may not seek medical help until the situation has become more serious and expensive. This study compared the differences in health care expenditures between obese and overweight individuals with and without disabilities. Of the 32 million individuals with disabilities in 2007, 30% were overweight and 37% obese. For each weight status level, people with disabilities had three times higher mean health care expenditures. There were significantly higher prescription drug costs in people with disabilities who were obese. These individuals also had significantly higher rates of hypertension, arthritis, high cholesterol and diabetes. Not only are initiatives needed for those who are obese, but preventative programs should be designed as well.

Anderson, W. L., Wiener, J. M., Khatutsky, G., & Armour, B. S. (2013). Obesity and people with disabilities: the implications for health care expenditures. Obesity, 21(12), E798-E804.

Research has shown larger differences in males and females in regard to obesity rates for those with and without intellectual disabilities. One weight loss program had subjects divide their meals into two. A walking regimine 2-4 days per week has been shown to help with weight loss, when paired with a diet program. Carer involvement has shown to be highly correlated to completion of programs. Quipping individuals with ID with the health risks of obesity may be necessary in order to reinforce behavioral changes.

Hamilton, S., Hankey, C. R., Miller, S., Boyle, S., & Melville, C. A. (2007). A review of weight loss interventions for adults with intellectual disabilities. Obesity Reviews, 8(4), 339-345.

Osteoporosis and diabetes occur at an earlier age than the general population in those with ID. Interventions were found that used DVDs or interactive games to disseminated information on health and exercise. Multi-component interventions have shown to produce lower hospital re-admissions, decrease in blood pressure and less pain and muscle stiffness. Health screening information was also presented, informing participants the importance of medical screening procedures by their doctors. This study found that community based initiatives resulted in benefits in the aging and disabled population. Habitual enviormental setting also has a meaningful impact on health.

Heller, T., Fisher, D., Marks, B., & Hsieh, K. (2014). Interventions to promote health: crossing networks of intellectual and developmental disabilities and aging. Disability and health journal, 7(1), S24-S32.

Evidence is clear that obesity is linked to many life-threatening and debilitating physical health and psychosocial issues. Estimates suggest that the prevalence of obesity is 2-3 times higher in children with disabilities, compared to their peers.Evidence also shows that many health behaviors formed as a child, carry over into adulthood. Surveys done at schools showed that children with disabilties reported less physical activity, more television viewing and less health eating patterns. Interventions done with children that have been successful include self-direction. This allows the child to join in on selecting their goals. Improvements in strength training has been shown in as little as 15 minutes of exercise. None of the studies done with the primary outcome of improved BMI, showed improvements. In most research done with pediatric obesity, children with disabilities are excluded. Parents are key in assisting in the weight loss process for children. Positive outcomes were linked to parental involvement and child self-direction. 

McPherson, A. C., Keith, R., & Swift, J. A. (2014). Obesity prevention for children with physical disabilities: a scoping review of physical activity and nutrition interventions. Disability and rehabilitation, 36(19), 1573-1587.

Most individuals with disabilities or chronic disease become less physically active. Risks from this inactivity are poor cardiorespiratory fitness, osteoporosis, impaired circulation to lower extermities, diminished self-concept and greater dependence on others for daily living. More disabled individuals have a higher metabolic cost for simple tasts, such as walking. Development of exercise guidelines is difficult, due to varying abilities. Home based exercise training, or that which can be done in a living facility, are most convenient. For those with disabilities, even exercise at lower than normal levels recommended for non-disabled individuals, has shown to be beneficial. Programs should be designed that include short term goals, variety and enjoyment. Few guidelines are present for making these exercise prescriptions at this time.

Durstine, J. L., Painter, P., Franklin, B. A., Morgan, D., Pitetti, K. H., & Roberts, S. O. (2000). Physical activity for the chronically ill and disabled. Sports Medicine, 30(3), 207-219.

This trial focused on the barriers and attitudes regarding exercise. Highest risks in non-exercise for elderly people with ID are HTN, osteoarthritis and heart disease. One significant determinant of exercise participation was carer perceived outcome of exercise. The highest correlated barriers found in this trial to exercise were; age, outcome expectations and access all by the carer. This study recommends that carers must be on the same team and educated to the positive impacts of exercise. Should try to identify benefits that are valued by individual and carer.

Heller, T., Hsieh, K., & Rimmer, J. (2003). Barriers and supports for exercise participation among adults with Down syndrome. Journal of Gerontological Social Work, 38(1-2), 161-178.

According to a 2010 report, 56% of adults with disabilities do no engage in any physical activity, compared to 36% of those without disabilities. Emerging research has found that recreational facilities are still a major barrier to those with disabilities, due to poor accessibility. One study found that when reviewing facilities in Oregon, not one was 100% compliant to the ADA (Americans with Disabilities Act). This study was done to identify barriers and facilitators associated with physical activity. Many reported difficulties with things like ramps and doors. Many facilities are lacking pool water chairs, velcro straps and trainers lack the knowledge to properly work with those who have disabilities. Members feel there needs to be more legislation to ensure ADA guidelines are followed. Facilities rarely have staff members that are designated to working with those who have disabilities.

Rimmer, J. H., Riley, B., Wang, E., Rauworth, A., & Jurkowski, J. (2004). Physical activity participation among persons with disabilities: barriers and facilitators. American journal of preventive medicine, 26(5), 419-425.

People with lower levels of education have shown to have higher levels of obesity. Several reviews have shown promising effects of web-based computer-tailored interventions for modifying diet and physical activity level. Video messages, opposed to strictly text, reduce the cognitive effort needed to process information. This project was set up in six steps, from needs assessment to follow-up on changes made. Goal setting was used as a method to help participants acheive the specific goals that they wanted. Studies have shown that the combination of multiple health behavior interventions can lead to greater weight loss. Individuals were also given coping information for when it became a challenge to stick with plans for goal attainment. In this specific trial, people with physical conditions, such as a disability, were not included. This trial excelled in increasing the choice that participants were able to make by choosing their own goals.

Walthouwer, M. J. L., Oenema, A., Soetens, K., Lechner, L., & De Vries, H. (2013). Systematic development of a text-driven and a video-driven web-based computer-tailored obesity prevention intervention. BMC public health, 13(1), 1.

This paper looked at methods to help improve quality of life for people living with autism. One method that has shown to increase social and communication skills is increased, structured, recreational time. One of the structured activities highlighted was hiking. In this population, this demonstrated positive results and is an active acitivity that can help to increase physical activity levels.

Matson, J. L., Hattier, M. A., & Belva, B. (2012). Treating adaptive living skills of persons with autism using applied behavior analysis: A review. Research in Autism Spectrum Disorders, 6(1), 271-276.

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NCHPAD Resources

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Physical exercise and the prevention of disability in activities of daily living in older persons with osteoarthritis. Archives of Internal Medicine

  • Both exercise programs prevented ADL disability; the relative risks.
  • Aerobic and resistance exercise may reduce the incidence of ADL disability in older persons with knee osteoarthritis.
  • Exercise may be an effective strategy for preventing ADL disability and, consequently, may prolong older persons' autonomy.

Improved upper-body endurance following a 12-week home exercise program for manual wheelchair users. Journal of rehabilitation research and development

  • Results of this study indicated that simulated propulsion exercise endurance was improved as a result of the home exercise program.

Effects of a 6-month exercise program on patients with multiple sclerosis A randomized study.

  • In the 7.62 m walk test, 22% of the exercising patients showed clinically meaningful improvements.
  • The exercise group also showed increased upper extremity endurance as compared to controls. 
  • Conclusions: Walking speed improved in this randomized study. The results confirm that exercise is safe for multiple sclerosis patients and should be recommended for those with mild to moderate disability.

Effectiveness of home exercise on pain, function, and strength of manual wheelchair users with spinal cord injury: a high-dose shoulder program with telerehabilitation.

  • Pain was reduced and function improved after the intervention.
  • Additional work is needed to determine the effectiveness compared with other interventions, as well as the potential for earlier intervention to prevent development of shoulder pain.

Effects of physical exercise therapy on mobility, physical functioning, physical activity and quality of life in community-dwelling older adults with impaired mobility, physical disability and/or multi-morbidity: a meta-analysis.

  • High-intensity exercise interventions seem to be somewhat more effective in improving physical functioning than low-intensity exercise interventions.
  • The effect on physical activity and quality of life was not evident and no definite conclusions on the most effective type of physical exercise therapy intervention can be drawn.

Exercise Intervention Research on Persons with Disabilities. What We Know and Where We Need to Go.

 

  • The study found that gaps in the current body of research around physical activity and disability are based upon small sample sizes for studies.  This is due to the difficulty in obtaining a large number of participants from the specific populations.

Microwave Fun User-Friendly Recipe Cards

  • Subject was able to easily follow numerical or color coded cards available to follow recipe.
  • Skills taught to him were planning a meal, removing the day’s current recipe card, obtaining the appropriate ingredients, returning index card to card file when finished.

Comparison of Self-Prompting of Cooking Skills via Picture-Based Cookbooks and Video Recipes

  • Students made fewer errors using the video system, than when using the picture-based system.
     

Assessment of Food Safety Knowledge of High School and Transition Teachers of Special Needs Students

  • Safety knowledge and training among high school and transition special education teachers, potential food safety risks due to a large volume of potentially hazardous foods prepared and served by these students, and lack of appropriate food safety resources for both target audiences—teachers and students. This survey strongly supports the need for outreach programming, training, and curriculum development for the teachers and their students.
     

High Tech Cooking: A Literature Review of Evolving Technologies for Teaching a Functional Skill.

  • As technology advances, so will the demands for response in special education to stay abreast of how these advances can be applied to improving the lives of personals with disabilities.
     

Using Video Prompting to Teach Cooking Skills to Secondary Students with Moderate Disabilities.

  • Three secondary students with moderate disabilities acquired cooking skills through a constant delay procedure used with video programming.
  • parents reported students independently applying skills they had in their own home after learning these skills.

Video Modeling and Prompting: A Comparison of Two Strategies for Teaching Cooking Skills to Students with Mild Intellectual Disabilities.

  • Results indicated increased independence following video system use by all three students with video modeling more effective for two students and video prompting more effective for the third. Future directions for research are presented.


 

A Pilot Study: Effectiveness of Basic Cooking Skills and Nutrition Education for Adults with Disabilities and Their Caregivers

 

  • Participants attended a six week interactive pilot program focused on balanced nutrition and basic cooking skills.
  • Participants were able to expand on their knowledge and demonstrate successful application. Lastly, participation of the homecare staff influenced environmental change.

 

Teaching young adults with developmental disabilities and visual impairments to use tape-recorded recipes: Acquisition, generalization, and maintenance of cooking skills

I Can Cook! A Template system for teaching meal-preparation skills

  • Presentation: Physical orientation to the tasks is the same for student and instruction, this slows student to view the procedure exactly as it is to be performed.
  • Guided Practice: afterwards for acquired skills.