Mid Sweden University

Background

Physical activity is essential for preventing noncommunicable diseases and improving health parameters. However, individuals with intellectual disabilities often struggle to meet recommended activity levels. Sustainable solutions and long-term follow-up are crucial for evaluating intervention efficacy.

Methods

This mixed-method longitudinal follow-up study examines the effects and experiences of a 12-week web-based exercise programme on individuals with intellectual disabilities (ID). Body composition, physical activity levels and waist circumference were measured before and after the 12-week intervention period as well as 12 months after the end of the intervention period (i.e., long-term follow-up). Experiences were analysed using semistructured interviews. In the data analysis, repeated measures ANOVA with Bonferroni correction was utilised to investigate changes over time.

Results

No significant changes were observed after 12 months, but there were effects on postintervention compared with preintervention on waist circumference. Some participants reported experiencing health benefits, which contributed to motivation, while others lacked motivation and were unaware that they could continue to exercise.

Conclusions

While improvements were noted post-intervention, sustaining these gains proved challenging during long-term follow-up. This study highlights the potential of web-based exercise programmes to support individuals with ID in increasing physical activity levels. However, the findings also underscore the need for more tailored and sustainable interventions, including structured support and ongoing engagement strategies, to enable lasting health behaviour change over time.

Background Physical activity is essential for health and well-being during adolescence, and active behaviour early in life predicts higher physical activity levels in adulthood. Although adolescents with intellectual disability (ID) consistently show lower activity levels than peers without ID, national environments—such as school structures, disability support systems, and access to inclusive leisure activities—may influence these patterns. There is limited evidence from Sweden, a country with distinct educational and support frameworks for youth with ID. The present study aimed to examine physical activity patterns among Swedish adolescents with and without ID using accelerometer data. Methods Physical activity was measured objectively using hip-worn accelerometers (ActiGraph GT3X) over seven consecutive days. This cross-sectional study included 45 adolescents with mild-to-moderate ID (median [IQR], 17.0 [14.0–19.0] years; 45.2% females) and 70 adolescents without ID (16.0 [15.0-16.3] years; 62.2% females). Physical activity was categorised as sedentary behaviour (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) and analysed across school days, weekend days, and separately for daytime and evening periods on school days. Results Overall, the relative amount of SB was similar between groups (p > 0.05), but significant differences were observed for LPA and MVPA. Adolescents with ID accumulated more LPA during school-day daytime hours (23% vs. 19%; p = 0.012), while peers without ID accumulated more MVPA during leisure time, such as school-day evenings (p = 0.025) and weekends (p = 0.039). For both groups, MVPA was higher on school days than on weekends (p < 0.001). Among adolescents with ID, SB increased markedly on weekends (72% vs. 77%; p < 0.001). Conclusion Adolescents with ID were generally less physically active than peers without ID, except during schoolday daytime, where the MVPA was similar and LPA was higher. Leisure time, particularly weekends and schoolday evenings, seems to be a critical period in achieving sufficient MVPA among adolescents with ID. Targeted interventions and coordinated support from key stakeholders such as school health services, paediatric health care, social care services and organised sports, with a particular focus on unstructured time, may help promote active lifestyles and reduce health disparities in this population.

Background: Health inequalities impact older adults and individuals with intellectual disabilities (ID) significantly, increasing their barriers to a healthy lifestyle. eHealth has emerged as a promising tool for addressing these public health challenges by facilitating greater access to interventions that promote physical activity. Non-communicable diseases (NCDs) are responsible for 71 percent of all global deaths, many of which are preventable through adherence to physical activity guidelines. As WHO identifies older adults and individuals with disabilities as priority groups for health interventions, this dissertation aims to assess whether web-based exercise can promote physical activity and health markers in these populations. Therefore, the aim of this dissertation was to evaluate the effectiveness, feasibility, and sustainability of web-based exercise interventions in target groups that rarely meet the recommended levels of physical activity: older adults and people with ID.

Method: This dissertation includes four studies, two with mixed method design, one with quantitative design and one with qualitative design. Study I evaluated the effectiveness and user experiences of an online resistance training program for older adults with pre- sarcopenia. Study II assessed the effects of a web-based exercise, designed for individuals with ID. Study III explored the experiences of support staff in assisting individuals with ID while participating in such a web-based exercise program. Study IV provided a long-term, 12-month, follow-up on Study II, assessing effects and experiences.

Results: Both web-based exercise programs achieved high adherence rates, with 80% in Study I and 83% in Study II. The exercise improved chair stand time (95% CI: 0.8–2.3, p < 0.001) and lean muscle mass i (95% CI: 0.06–0.72, p < 0.05) for older adults (Study I) and reduced fat mass (95% CI: 0.9-2.9, P < 0.001) and waist circumference (95% CI: 0.99-5.01, P = 0.009) for individuals with ID (Study II). Additionally, older adults reported feeling more active and noticing physical improvements (Study I). Feedback from support staff (Study III) underscored the importance of communication, structure, and motivation, within support teams, to foster physical activity. Study IV observed no sustained long-term effects, though some participants reported health benefits that motivated continued exercise, while others cited low motivation or lack of post-program support.

Conclusion: The conclusion from this dissertation was that a web-based program seems effective and feasible for older adults with pre-sarcopenia and adults with ID, short-term. Adaptability and accessibility were two crucial building blocks for successful implementation for these target groups. In addition, the support structure was of high importance, affecting long-term sustainability and requiring further investigation.

Bakgrund: Hälsoskillnader påverkar äldre vuxna och personer med intellektuell funktionsnedsättning (IF) i hög grad, vilket ökar utmaningarna för en hälsosam livsstil. eHälsa har visat sig vara ett lovande verktyg för att möta dessa folkhälsoutmaningar genom att underlätta tillgången till interventioner som främjar fysisk aktivitet. Icke-smittsamma sjukdomar står för 71 procent av alla globala dödsfall, varav många kan förebyggas genom att följa riktlinjer för fysisk aktivitet. Eftersom världshälsoorganisationen identifierar äldre vuxna och personer med funktionsnedsättningar som prioriterade grupper för hälsointerventioner, syftar denna avhandling till att undersöka om digital träning kan främja fysisk aktivitet och hälsomarkörer hos dessa grupper. Målet var därför att utvärdera effektiviteten, genomförbarheten och hållbarheten av webbaserade träningsinterventioner i målgrupper som sällan uppnår de rekommenderade nivåerna av fysisk aktivitet: äldre vuxna och personer med IF.

Metod: Avhandlingen omfattar fyra studier, två med en mixed- method-design, en med kvantitativ design och en med kvalitativ design. Studie I utvärderade effektiviteten och genomförbarheten av ett onlineprogram för styrketräning för äldre vuxna med pre- sarkopeni. Studie II utvärderade effekterna av ett webbaserat träningprogram, utformad för personer med IF. Studie III undersökte erfarenheterna hos stödpersonal som assisterar personer med IF vid deltagande i ett webbaserat träningsprogram. Studie IV utvärderade en 12-månaders långtidsuppföljning av Studie II och bedömde dess effekter och undersökte deltagarnas erfarenheter.

Resultat: Båda träningsprogrammen hade hög följsamhet, med 80 % i Studie I och 83 % i Studie II. Träningen förbättrade uppresningstid (95% KI: 0.8–2.3, p < 0.001) och muskelmassa (95% KI: 0.06–0.72, p < 0.05) för äldre vuxna (Studie I) samt minskade fettmassa (95% CI: 0.9-2.9, P < 0.001) och midjeomfång (95% CI: 0.99- 5.01, P = 0.009) för personer med IF (Studie II). Dessutom rapporterade äldre vuxna att de kände sig mer aktiva och märkte fysiska förbättringar (Studie I). Stödpersonalens feedback (Studie III) betonade vikten av kommunikation, struktur och motivation inom stödteam för att främja fysisk aktivitet. Studie IV visade inga långsiktiga effekter, även om vissa deltagare rapporterade hälsofördelar som motiverade fortsatt träning, medan andra nämnde låg motivation eller brist på stöd efter programmets slut.

Slutsats: Slutsatsen från denna avhandling var att ett webbaserat program verkar vara effektivt och genomförbart för äldre vuxna med pre-sarkopeni och vuxna med intellektuell funktionsnedsättning på kort sikt. Anpassningsmöjlighet och tillgänglighet var två avgörande byggstenar för en framgångsrik implementering för dessa målgrupper. Dessutom var stödstrukturen av stor betydelse, vilket påverkar långsiktig hållbarhet och kräver vidare undersökning.

Background

People with intellectual disabilities are less physically active and suffer from ill-health more than the general population. Support staff play an important role in the person's life. This study aimed to explore the support staff's experiences regarding the feasibility of adapted web-based exercise for people with intellectual disabilities.

Method

Participants with intellectual disabilities living in community-based settings were recruited for a web-based exercise study. Eight semi-structured interviews were carried out with their support staff before and after the intervention period.

Results

The main theme, ‘Support staff are crucial for feasibility’ encompasses the importance of communication, structure, and motivation in improving physical activity for people with intellectual disabilities.

Conclusion

The experiences of support staff, indicate that a web-based exercise program is feasible for the target group, and one way to overcome challenges for PA, where the role of the staff is crucial.

Adults with intellectual disability (ID) have higher degree of sedentary lifestyle and participate in physical activity less compared to the general population. The aim of this cross-sectional study was to analyse if participation in Special Olympics increase the level of physical activity (PA) and influence physical health aspects such as BMI, muscular strength and aerobic fitness for people with ID. Data were analysed from the Special Olympics Sweden Invitational Games 2020, on athletes (n=38) and non-athletes with ID (n=20), of strength (partial sit-up-, seated push-up-, handgrip- and timed sit to stand test), aerobic fitness (2 min step up test), BMI and a PA-questionnaire. Athletes showed higher levels of PA moderate intensity, both groups had high BMI, low levels of aerobic fitness and strength. This study indicate that Special Olympics athletes and non-athletes with ID need to increase their physical activity of both strength training and PA higher intensity to improve physical health aspects.

BackgroundPhysical inactivity and low muscle mass are risk factors for falls, fractures and overall poor health. However, physical activity is reduced with increased age and only a fraction of older adults engages in resistance training (RT). Thus, strategies that facilitate RT among older adults are needed. The aim of the present study was to evaluate the effectiveness and user experience, and explore barriers and motivators toward an online delivered, home-based RT program in older adults with low muscle mass. MethodsThirty men and women, 70-71 years of age with low muscle mass were assigned home-based RT with online exercise videos (3 times/week, 45 min/session for 10 weeks) accompanied with an initial supervised try-out session. Quantitative outcome measures included changes in lean body mass and physical function. Semi structured one-to-one interviews with a subset of the participants (n = 8) were also conducted to generate a greater understanding of the participants experience of the digitally supported RT. The material was transcribed and analyzed with qualitative content analysis. ResultsTwenty-seven participants (90%) completed the trial. Lean body mass increased by 0.39 kg (95% CI: 0.06-0.72, p < 0.05) and chair stand time improved by 1.6 s (95% CI: 0.8-2.3, p < 0.001). No significant improvements were seen for balance or gait speed. The theme "Engaging in Digital Resistance Training with Personal Adaptation Leads to a Sense of Strength and Vitality" captured the participants experience of the intervention, where a sense of how the body was changing toward a more active lifestyle was described. Instructions, feedback, and intrinsic motivation were identified as key elements for compliance. ConclusionThe online delivered RT program for older adults with low muscle mass was feasible based on high compliance, user satisfaction, increased lean mass and improved chair-stand time. The participant experiences may explain the high compliance to the intervention and effects on outcomes. Based on these results, online delivered RT could be an accessible exercise routine for older adults with low muscle mass. More research is needed to verify the present findings and assess changes in a long-term perspective.

Background: Individuals with intellectual disability (ID) are less physically active, have a higher body mass index (BMI) and are at greater risk for cardiovascular diseases (CVDs) than people without ID. The purpose of the study was to explore the effectiveness of a web-based training programme, consisting of 150 min of activity per week, on the health of people with ID.

Method: Participants with ID living in supported accommodation (n = 28, 48% female, age = 36.4 ± 9.56 years) participated in a web-based training programme, consisting of a combination of exercises (endurance, strength balance and flexibility) of moderate intensity, 50 min, three times per week for 12 weeks. The body composition and waist circumference (WC) were measured, and questionnaires were used to assess enjoyment, quality of life (QoL) and physical activity (PA) level. Descriptive statistics and pairwise comparison pre and post intervention were carried out.

Results: A total of 22 out of 28 participants completed the 12-week training intervention with 83% mean attendance of training sessions. The intensity of the PA level increased and a decrease in fat mass of 1.9 ± 2.4 kg, P < 0.001 and WC of 3 ± 5 cm, P = 0.009 were observed. Enjoyment of training sessions was 3.9 out of 5, and no differences in QoL were found.

Conclusion: A web-based training programme is an effective tool for improving health parameters of people with ID and offers a new way for caregivers to enhance the PA for the target group.