Why walking for people with intellectual disabilities?
Walking has been identified as an answer to sedentary lifestyles in national and international activity programmes accessible to many different populations. The World Health Organisation (2013) acknowledged walking as a core foundation for physical activity promotion in socially disadvantaged and vulnerable groups which include people with intellectual disabilities. Primary studies have shown walking as the most common form of physical activity, a solution to insufficient physical activity and having a positive impact on health of people with intellectual disabilities (Temple and Stanish, 2008). Walking is one of the least expensive and broadly accessible forms of physical activity, rarely associated with physical injury. Walking can easily be adopted by people of all ages, including those who have never participated in physical activity, and specifically by people with intellectual disabilities (Stanish and Draheim, 2007).
What is a walking intervention?
A walking intervention is a programme targeted at promoting walking as a physical activity for people with intellectual disabilities. The aim of the intervention is to promote walking in people with intellectual disabilities with an expected outcome to increase daily steps taken and change physical activity behaviours. There are 3 performance objectives to consider in a walking intervention;
- Pedometer objective:
To participate in wearing a pedometer as part of the walking intervention.
- Social support objective:
To participate in developing social support to help a participant’s capacity to walk.
- Counselling objective:
To participate in a weekly counselling session and record weekly steps.
All 3 performance objectives are used together as a motivational tool to promote walking as an activity over a set number of weeks. The expected change in the walking intervention is to increase steps and improve physical activity among people with intellectual disabilities who walk less than 5,000 steps daily, and to maintain or increase steps for those who walk more than 5,000 (Figure 2).
- Pedometer objective
In preference, an OMRON (Figure 1) pedometer can be used which keeps details of the steps taking during the day, and includes other features such as an automatic reset function at midnight and a seven-day memory. The pedometer has a strap and clip that make it easy to secure to a belt or in a trouser pocket. The pedometer is supplied with an instruction guide which provides full instruction on setting up, monitor and recording. The pedometer instruction guide has to be read, understood and followed in order to provide reliable and valid step results. Particpants should practice wearing the pedometer for a few days before starting a walking intervention and recording daily steps.
Figure 1: OMRON Pedometer
|Figure 2: Steps Table (Tudor-Locke et al., 2011)|
How many steps a day?
In a review of the public health recommendations in terms of daily steps, Tudor-Locke et al. (2011) found special populations, people with disabilities and chronic illness, average 1,000 to 8,000 steps per day. Recognising that people with intellectual disabilities may be limited in their everyday activities, it may not be possible to set an exact recommended number of daily steps for any one individual or group.
However, in line with national physical activity guidelines for people with disabilities, steps goals are set as any increase in daily step count relative to individual baseline values (DOHC, 2009). Any increases in the number of steps are acceptable and can confer a health benefit on that person. People with intellectual disabilities with no specific physical or mobility difficulty can use the global daily amount of 10,000 steps as a goal to reach incrementally (Tudor-Locke et al., 2011; Figure 2).
- Social support objective
Social support is an ongoing aspect of care found within intellectual disabilities, where the focus is to identify and maintain social support that aids walking. Social support by family, friends, staff and workmates has been shown to help people with intellectual disabilities participate in physical activities. Participants may need help in identifying and recording both steps and those people who provide social supports for walking. A step diary can record social support contributors, while recording steps taken each day or on a weekly basis. A “circle of friends” exercise may be used, which can identify levels of friends from the closest friend through distant friends, family members, everyday acquaintances to those not known well. The “circle of friends” exercise facilitates a discussion around how a social circle of friends and acquaintances can help participants in walking.
- Counselling objective
Counselling, alongside pedometers and social supports, has been identified as a motivational component in walking intervention studies (Mitchell et al., 2013). People with intellectual disabilities lack motivation to maintain physical activity over a period of time, and do not have effective motivational strategies to be sustainable (Hulzler and Korsensky, 2010). Counselling, along with the participant’s education, has been found to act as a motivator to increase physical activity levels in people with intellectual disabilities (Melville et al., 2009). Those that provide counselling benefit in parallel with people with intellectual disabilities. Through participation family, friends and care staff benefit from a positive sense of control over their ability to counsel and support people with intellectual disabilities to achieve greater activity levels (Martin et al. 2011).
Where people with intellectual disabilities have limited or inaccurate knowledge about walking, intervention, or health, counselling is a means to motivate participation, improve knowledge and provide a sense of empowerment among people. Counselling can focus on any one of three aspects of the intervention, with pedometer use and recording steps and circle of friends that support walking. In addition, other motivations such as the benefits of walking can be used, facilitating different individual cognitive levels, interests and abilities in walking. At the end of a counselling session, a review of the step diary and weekly step count can be carried out where a step goal can be made by participants.
A special day with certification can endorse and celebrate the achievement in a walking intervention, recognising successes made by individuals within their community. A presentation can be an acknowledgement of both the participant and their circle of friends, which provide a unique bond necessary to maintain and promote the sustainability of walking. Finally, a dog-walking program has the potential as a long-term catalyst to encouraging walking and friendly encounters, which can help people with intellectual disability build social connections and walk more in their communities (Bould et al., 2018).
But then again, a dog is another story.
www.getirelandactive.ie: For information on national physical activity guidelines
http://www.irishheart.ie: For Slí na Sláinte walking routes & maps in Dublin and Ireland
http://www.walkingroutes.ie: For lists, trails and walks in Ireland.
Michael Mc Keon
School of Nursing
Dublin City University
Bould, E., Bigby, C., Bennett, P.C. and Howell, T.J. (2018) ‘More people talk to you when you have a dog’-dogs as catalysts for social inclusion of people with intellectual disabilities. Journal of Intellectual Disability Research 62(10):833-841
Department of Health and Children, Health Service Executive (2009) The National Guidelines on Physical Activity for Ireland. Dublin: The Stationery Office.
Hulzler, Y. and Korsensky, O. (2010) Motivational correlates of physical activity in persons with an intellectual disability: a systematic literature review. Journal of Intellect Disability Research, 54(9):767-86
Martin E. A., McKenzie K. B., Emily Newman, E., Bowden K. C. and Graham Morris, P. (2011) Care staff intentions to support adults with an intellectual disability to engage in physical activity: An application of the Theory of Planned Behaviour. Research Developmental Disabilities 32. P. 2535–2541
Melville CA, Hamilton S and Miller S (2009) Carer knowledge and perceptions of healthy lifestyles for adults with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities 22(3): 298–306.
Mitchell, F., Melville1, C., Stalker, K., Matthews, L., McConnachie, A., Murray, H., Walker, A., and Mutrie, N. (2013) Walk well: a randomised controlled trial of a walking intervention for adults with intellectual disabilities: study protocol. BMC Public Health, 13:620.
Stanish, H. I. and Draheim, C. C. (2007) Walking activity, body composition and blood pressure in adults with intellectual disabilities. Journal of Applied Research in Intellectual Disability, 20:183-190.
Temple, V. A. and Stanish, H. I. (2008) Physical activity and persons with intellectual disability: some considerations for Latin America. Salud Publica De Mexico, 50: 185-193.
Tudor-Locke, C., Craig, C. L., Brown, W. J., Clemes, S. A., De Cocker, K., Giles-Corti, B., Hatano, Y., Inoue, S., Matsudo S. M., Mutrie, N., Oppert, J., Rowe, D. A., Schmidt, M.D., Schofield, G. M., Spence, J. S., Teixeira, P. J., Tully, M. A., and Blair, S., N. (2011) How many steps/day are enough? for adults. International Journal of Behavioral Nutrition and Physical Activity, 8:79
World Health Organisation (2013) Physical activity promotion in socially disadvantaged groups: principles for action, PHAN Work Package 4., Final Report. WHO Regional Office for Europe Denmark