A multi-component universal intervention to improve diet and physical activity among adults with intellectual disabilities in community residences: A cluster randomised controlled trial

Abstract

People with ID have an increased risk for unhealthy diets, physical inactivity and weight disturbances. The aim of the current study was to investigate the effectiveness of a novel and complex intervention to improve diet and physical activity, targeting both caregivers and residents, in community residences for people with ID. A three component intervention based on Social Cognitive Theory was developed, including: (1) appointment of a health ambassador in each community residence attending network meetings, (2) a study circle for caregivers, and (3) a health course for the residents. The intervention lasted for 12-16 months and allowed for some local tailoring. A cluster randomised controlled trial, randomised at residence level, was conducted to evaluate the effects of the intervention. Thirty community residences for people with mild or moderate ID in Stockholm County, Sweden, were included. A total of 130 participants, 74 women and 56 men aged 20-66 years, entered, and 129 participants completed the study. The primary outcome was physical activity, measured by pedometry. Secondary outcomes were BMI, waist circumference, dietary quality measured by digital photography, satisfaction with life assessed with a scale, and work routines assessed with a questionnaire. Outcomes were related to intervention fidelity. A positive intervention effect was found on physical activity, with an average increase of 1608 steps/day among participants in the intervention group (P=0.045). The effect size was 0.29 (Cohen's d). The type of residence was found to be an effect moderator. A positive intervention effect was found as well on work routines, with an average increase of 7.1 percentage points on a self-assessment scale among residences in the intervention group (P=0.016). No significant effects were found on BMI, waist circumference, dietary quality, or satisfaction with life. In conclusion, this innovative intervention was effective in improving physical activity and work routines. It is likely that even greater effects could be achieved by improvements in implementation strategies, leading to higher fidelity.

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

“…The studies [163][164][165][166] were generally of high quality; in particular, all of the studies achieved at least a good quality rating for internal and external validity. However, two 163,165 of the four studies failed to account for all of the participants when concluding the study, and three [163][164][165] of the four studies did not report on whether or not the studies were sufficiently powered to detect differences.…”

“…One of the authors did not reply, and we were informed by the remaining three that their study results were still awaiting publication and could not be included in the review. In total, we identified only four studies [163][164][165][166] for inclusion in this review.…”

“…The studies [163][164][165][166] covered three countries (USA, UK and Sweden). Two studies 163,164 were single arm, and two studies 165,166 had a control group.…”

“…Bergström et al 166 conducted a two-armed trial in community residential homes, targeting both people with ID and their carers. The intervention offered a 'study circle' for carers and also an appointed health ambassador at each residential home.…”

“…164 Both cohorts 163,164 were overweight to obese when they were enrolled into the study. For the further two studies, 165,166 for which the cohort was not recruited based on health status, one of the studies 166 showed significant positive improvements in waist circumference, BMI and steps per day in those who received the intervention compared with the control subjects; the second study 165 did not show any significant differences between control and intervention arms ( …”