WALKING: A SOLUTION TO INACTIVITY FOR PEOPLE WITH INTELLECTUAL DISABILITY

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Michael McKeon, DCU School of Nursing and Human Sciences says that, for those with an ID, walking is one answer to a sedentary lifestyle.

Research suggests that although the health of people with ID has improved over the past 30 years, they still have higher rates of both primary and secondary medical conditions, undiagnosed diseases and unmet health needs compared to the non-ID population (McCarron et al. 2011). One of the most significant current discussions in intellectual disability concerns the health risks from inactivity which lead to increase risk factors for non-communicable diseases such as type-2 diabetes and heart disease (Taggart and Cousins 2014). People with ID do not meet current physical activity guidelines and have high inactivity and poor fitness (Phillip and Holland 2011). Along with low rates of physical activity, poor diet and secondary health conditions contain their abilities to be active (RCN 2011).

To date, studies have provided a narrow view of physical activities in ID, without acknowledging the complexities involved. They are also limited by small sample sizes, over-reliance on mild ID, and a focus only on the active person (Temple 2010). The past decade has seen the acceptance of global physical activity guidelines which recommend moderate physical activity intensity of over 30 minutes a day. This is in addition to muscular strength and endurance exercise on a minimum of two-days per week (Activity for Ireland 2009). While physical activity guidelines can be adapted to various disability groups, no specific guidelines exist for people with ID and physical activity interventions are very limited (Bartlo and Klein 2011). Yet, inactivity has heightened the need for health promotion, where it is now necessary to develop health promotion strategies and interventions designed to promote physical activity in people with ID (Marks and Sisirak 2012).
Interventions to promote physical activity have become a priority in public health worldwide (WHO 2004). Physical activity interventions need to be sustainable, designed to target different groups, and specifically designed to support people with ID in order to improve their poor health profile (McDermott et al. 2012).

However physical activity programmes are often not available, or not accessible and adaptable, and are difficult to sustain for an ID population (Bartlo and Klein 2011). Several physical activity interventions in ID, however, have been reported to give a range of benefits, such as improvements in BMI, strength and balance and benefits in quality of life and social competence (Hobbs et al. 2013). Studies have recommended that interventions in ID need to be developed and translated into practice for long-term effectiveness. Walking has been acknowledge as a potential key activity (Bartlo and Klein 2011; Mc Dermott et al. 2012).

Walking is one intervention that has been identified as an answer to inactivity and sedentary lifestyles in national and international activity programmes accessible to many populations (DOHC 2009). The World Health Organisation (2013) acknowledged walking as a core foundation for physical activity promotion in socially disadvantaged groups. It has also been recognised as the most frequent activity, a solution to insufficient physical activity and having a positive impact on the health of people with ID (Temple and Stanish 2008). The main areas of walking that people with ID were involved in were walking as a mode of transport, a way of getting around and walking as part of a person’s job or employment.

However, studies have still found low walking levels in ID populations. Walking regularly undertaken was of short duration and was insufficient for health benefits (Peterson 2008). While walking was found to be the most popular physical activity undertaken, the intensity of walking was low and evenings and weekends were especially inactive time periods (Finlayson et al. 2009). While the intensity of walking may be too low to achieve any health benefits, people with ID can benefit from increasing the intensity of walking alone (Stanish and Draheim 2007). Walking is an area of physical activity that has long-term sustainability and low-cost characteristics, with minimum physical and psychological barriers for people with ID (Dowling et al. 2012). There is still insufficient evidence on the effectiveness of walking interventions, suggesting that further research is necessary (Mitchell et al. 2013). Yet a number of recent studies on physical activity in ID used walking as a way of exploring and measuring physical activity levels (Mc Dermott et al. 2012). A small number of studies found that walking was a successful activity for people with ID. Todd and Reid (2006) found walking a good intervention to promote physical activity for people with autism. Other studies found 14% to 21% of people with ID can accomplish 10,000 steps daily, where people were more active on weekdays than weekends and were more active in the morning, with the least active period during the evenings and at weekends (Peterson et al. 2008; Stanish and Draheim 2005). However the same research found that more than 80% of people with ID do not achieve the 10,000 steps per day and walking was carry out at a low intensity insufficient for health benefits. Lifestyle changes can help improve walking levels, beginning with the measurement of the number of steps taken, using a pedometer.

Pedometers are used to measure the number of steps taken each day as evidence of a person’s activity or inactivity. Counting steps can help promote physical activity and confront a sedentary lifestyle (Tudor-Locke and Bassett 2004). Pedometers are easily accessible and are available as a free app on many mobile phones. Evidence has shown that pedometers as objective and inexpensive, and that they are reliable measurements of walking in ID (Zhang et al.2012). A classification system was outlined to show how many daily steps (counted by a pedometer) was recommended for different levels of physical activity. Tudor-Locke and Bassett (2004) set indices for steps in healthy adults to determine physical activity levels. Fewer than 5000 steps is sedentary; 5000 to 7499 steps is low active; 7500 to 9999 steps is somewhat active; more than 10,000 is active; and more than 12,500 is highly active. Although 10,000 steps has been set for a healthy adult, for older people and people with ID that level may present an inappropriate goal. However, 10,000 steps per day was the equivalent benchmark for 30 minutes a day of physical activity recommended for a healthy adult (DOHC 2009). A full 7-day pedometer measurement which captures weekdays and weekends can provide and predict reliable average weekly steps and indicates physical activity levels for people with ID (Temple and Stanish 2009).

Pedometers can be used as a tactic to increase self-esteem and motivation, by initiating goal setting and self-monitoring to increase steps and reduce sedentary times (Glanz and Bishop 2010). The WHO (2013) recommended that physical activity interventions should focus on behavioural and motivational changes within individuals to promote greater physical activity. Motivation was identified for adults with ID as a major component in developing and enabling physical activities (Frey et al. 2008). Consultation or coaching using pedometers has also been identified as a motivational component in walking intervention studies for people with ID (Mitchell et al. 2013). However, studies have suggested that people with ID lack motivation to maintain physical activity programmes over a sustained period of time and programmes lack evidence of effective motivational strategies to support physical activity interventions (Hulzler and Korsensky 2010).

There are many websites on walking that can provide a variety of information for the novice walker, for example the excellent websites of the Irish Heart Foundation and the Get Ireland Active programme. Research by the Irish Heart Foundation has developed the Slí na Sáinte walking programme to encourage people of all ages and abilities to walk more. The programme can be found online and has detailed information in an easy-to-use format on walking, how to get started, maintain, improve and set challenges. Get Ireland Active is another good website that supplies a variety of information to help support people to be active and to walk more. If you do not wish to use the computer or to read up on the subject, just buy a pedometer, put it in your pocket and start walking—the interest and motivation will come from the number of steps you take each day.

Further Information

Department of Health and Children (2009) The National Guidelines on Physical Activity for Ireland. www.getirelandactive.ie/
Irish Heart Foundation (2014) Sli na Slainte. www.irishheart.ie/

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