Abstract

Little information has been reported on the leisure time physical activity (LTPA) habits of adults with mental retardation. Prevalence of physical inactivity and recommended LTPA of adults with mild to moderate mental retardation who live in community settings was described. Adults with mental retardation (76 men, 74 women) reported their physical activity habits. Overall, men and women who resided in community settings were similarly inactive, with 47% to 51% of individuals participating in little to no LTPA. Forty-two to 47% of them reported participation in moderate to vigorous LTPA five or more times per week. Limitations to quantifying physical activity through questionnaire process is discussed and development and implementation of programs designed to increase physical activity levels recommended.

Editor in charge: Steven J. Taylor

The consequences associated with living a sedentary lifestyle, which include an elevated risk for coronary artery disease, stroke, and obesity, have been well-documented (U.S. Department of Health and Human Services, 1996). Individuals with less education, lower incomes, and blue-collar employment are more likely to be physically inactive than those with more education and higher paying white-collar employment (Crespo, Ainsworth, Keteyian, Heath, & Smit, 1999). Adults with mental retardation represent a disability group who fit into the low education, low income, and blue-collar employment category (Braddock, 1999; Fujiura, 1998) and who are likely to be physically inactive (Beange, McElduff, & Baker, 1995). Even though adults with mental retardation have consistently been reported to possess elevated risk factors for coronary heart disease and stroke and elevated obesity rates (Draheim, McCubbin, & Williams, 2002; Draheim, Williams, & McCubbin, 2002; Rimmer, Braddock, & Fujiura, 1993; 1994; Rimmer, Braddock, & Marks, 1995), little information has been reported specifically on the physical activity habits of adults with mental retardation. Two large studies in which researchers investigated physical activity of adults with mental retardation have reported that adults with mental retardation were less active than those without mental retardation (Beange et al., 1995) and that adults with mental retardation residing in group homes were less active than those residing in institutional settings (Rimmer et al., 1995). However, the prevalence of recommended physical activity was not reported in either study. The prevalence of recommended physical activity and physical inactivity are needed to determine the risk for chronic diseases that may be attributed to inadequate physical activity in adults with mental retardation.

Since the deinstitutionalization of adults with mental retardation, those with mild to moderate mental retardation are more likely to live in community settings with less direct supervision than are adults with more severe mental retardation (Braddock, 1999; Fujiura, 1998). Less direct supervision of individuals residing in community settings has likely allowed for more personal choice of whether to participate in regular physical activity. Furthermore, describing the types of community-based activities in which adults with mental retardation are currently participating may help to identify which specific physical activities to include in effective health promotion programs aimed at reducing their risk for coronary heart disease, stroke, or obesity (Pate et al., 1995, Rimmer, 2000; U.S. Department of Health, 1996).

Our purpose in the present study was to evaluate the prevalence of physical inactivity and the prevalence of the recommended frequency of physical activity in adults with mild to moderate mental retardation residing in community settings. We also evaluated the frequency of participation in specific physical activities of this sample population.

Method

Participants

Participants were 150 adults (76 men, 74 women) with mild to moderate mental retardation (Luckasson et al., 1992) who were between the ages of 19 and 65 years. Participants were recruited through each county's Office of Developmental Disabilities Services and area Arc offices of two Northwestern states. Due to confidentiality policies of the service agencies, researchers were not allowed to recruit participants directly until the service agencies performed an initial screening of interested individuals. We asked careproviders to identify eligible potential participants based on (a) diagnosis of mental retardation (Luckasson et al., 1992); (b) the need for intermittent to limited support for independence/interdependence, productivity, community integration, and satisfaction (Luckasson et al., 1992); (c) residence in community settings; (d) no previous diagnosis of diabetes, myocardial infarction, or stroke; and (e) stated interest in participation). Also due to confidentiality policies of the service agencies, information about individuals not agreeing to participate was not available to the researchers. Only ambulatory individuals were included. The participants were also involved in a larger study investigating the association between physical activity and cardiovascular disease risk factors in adults with mental retardation. Because associations between physiological risk factors for cardiovascular disease may differ for individuals with diabetes and individuals with known cardiovascular disease, persons with diabetes and known cardiovascular disease were excluded from the study.

All procedures and consent forms were approved by the University's Institutional Review Board for the Protection of Human Subjects. All participants (and parents or guardians when needed) signed an informed consent form. The participants and the direct care staff members were each compensated for their time, effort, and contributions to the study with a $15.00 personal check.

Physical Activity Prevalence

The National Health and Nutrition Examination Survey III, Physical Activity Survey was used to assess the participants' regular physical activity habits (National Center for Health Statistics, 1994). The physical activity survey was administered through an interview with the participant and the participant's direct care provider to assist with the questions as needed. The intensity of each reported activity was estimated using the Ainsworth Compendium for Physical Activities, which provides estimates for specific activities in metabolic equivalents (METs) (Ainsworth et al., 1993). A MET is a unit of energy expenditure that is expressed in multiples of the energy used at rest (i.e., 1 MET = energy expenditure at rest, 2 METs = twice the energy expenditure of rest). The MET values from the Ainsworth Compendium for Physical Activities were compiled from multiple published studies of adults without mental retardation (Ainsworth et al., 1993). Moderate to vigorous LTPA was defined as any physical activity greater than or equal to 3.5 METs (Crespo et al., 1996). Vigorous LTPA was defined as any activity greater than 6.0 METs (Crespo et al., 1996). Individuals who reported that they did not participate in any type of LTPA were classified as participating in no LTPA. Participants were also classified as participating in little to no LTPA, recommended LTPA, and regular vigorous LTPA (Crespo et al., 1996). Little to no LTPA was defined as participating in moderate to vigorous LTPA less than 3 times per week. The United States Department of Health and Human Services and the American College of Sports Medicine have recommended that individuals participate in moderate to vigorous LTPA at least five or more times per week (recommended LTPA) to decrease their risk for cardiovascular disease (Pate et al., 1995; U.S. Department of Health and Human Services, 1996). The prevalence of participants engaging in regular vigorous LTPA (vigorous LTPA more than 3 times per week) was also calculated.

Height, Weight, and Body Mass Index

Weight was measured to the nearest .5 kg with participants dressed in lightweight clothing. Height was measured to the nearest .5 cm. Body Mass Index (BMI) was calculated by dividing the weight in kilograms by the height in meters squared (BMI = kg body weight/height in m2).

Statistical Analysis

Means and standard deviations (SDs) of age, height, weight, and BMI were calculated using SPSS statistical package for Personal Computers version 9.0. Independent t tests were calculated to determine whether the age, height, weight, and BMI differed between men and women with mental retardation. Separate chi-square tests were used to determine whether the prevalence of participants with Down syndrome and the prevalence of participants living in each type of residential setting differed between men and women.

The prevalence of participants reporting low (no LTPA and little to no LTPA) and higher (recommended LTPA and regular vigorous LTPA) physical activity habits and the prevalence of specific physical activities reported were also calculated using the SPSS package. Separate chi-square tests were used to determine whether the prevalence of adults with Down syndrome participating in no LTPA, little to no LTPA, recommended LTPA, and regular vigorous LTPA differed from adults without Down syndrome. Separate analyses were calculated for overall sample, for men only, and for women only. Chi-square tests were used to establish that the prevalence of men with mental retardation participating in the varying degress of LTPA differed from women with mental retardation. Significance was set at .05 for all statistical comparisons.

Results

The mean age, height, weight and BMI of the men and women participating in the study are presented in Table 1. Women were shorter, t(148) = −6.14, p < .001, and had a higher BMI, t(148) = 3.30, p = .001, than the men. The prevalence of participants with Down syndrome and the prevalence of participants living in each residential setting are presented in Table 1. A greater proportion of women than men lived in semi-independent living settings, χ2 (2, N = 53) = 4.20, p = .04. Similarly, a greater proportion of women with Down syndrome than men with Down syndrome lived in semi-independent living settings, χ2 (2, N = 13) = 3.80, p = .03.

Table 1

Participant Characteristics

Participant Characteristics
Participant Characteristics

There were no differences in the prevalence of no LTPA, little to no LTPA, recommended LTPA, or regular vigorous LTPA between men with mental retardation with and without Down syndrome nor were there differences related to prevalence between women with mental retardation with and without Down syndrome or between all participants with mental retardation with and without Down syndrome.

Overall, men and women had a similar prevalence of inactive and active LTPA habits. There were no differences in the prevalence of no LTPA, little to no LTPA, recommended LTPA, and regular vigorous LTPA between all men and women with mental retardation. Thirteen percent of all individuals participated in no LTPA and 49%, in little to no LTPA, whereas 45% of all participants participated in the currently recommended LTPA, but only 1% participated in regular vigorous LTPA 3 or more times per week. The prevalence of inactive and active men and women with mental retardation are presented in Table 2. Nine of the participants (4 women, 5 men) reporting physical activity habits did not meet the requirements of the physical activity categories in Table 2. The reported physical activity habits fell between the little to no LTPA category and the recommended LTPA category (M = 3.6, SD = .5) bouts of moderate to vigorous physical activity per week and were not presented in Table 2. The 4 women were between 24 and 31 years of age. One of the 4 women had Down syndrome. The 5 men were between 21 and 45 years of age. Four of the 5 men had Down syndrome.

Table 2

Adults With Mental Retardation Participating in Physical Activity by Level of Activity (in %)

Adults With Mental Retardation Participating in Physical Activity by Level of Activity (in %)
Adults With Mental Retardation Participating in Physical Activity by Level of Activity (in %)

Walking and cycling were the two most prevalent physical activities reported for both men (54.0% and 42.1%, respectively) and women (56.8% and 31.1%, respectively). The prevalence of each specific physical activity reported, along with the rank of the most prevalent physical activities reported, and estimates of the intensity of the physical activities reported are presented for men and women in Table 3.

Table 3

Characteristics of Physical Activities Reported by Participants

Characteristics of Physical Activities Reported by Participants
Characteristics of Physical Activities Reported by Participants

Discussion

In the present study the prevalence of inactivity was high for both men and women with mental retardation. The overall prevalence for no LTPA and little to no LTPA (10.5% and 51.3%, respectively) for men with mental retardation is similar to that reported for men in the general population (13% and 48%, respectively) (Crespo et al., 1996). Also, the overall prevalence for no LTPA and little to no LTPA (14.9% and 47.3%, respectively) for women with mental retardation is similar to that reported for women in the general population (23% and 57%, respectively) (Crespo et al., 1996). When considering that the population of the United States is typically judged to be sedentary, the similarities between the present findings and those for the general population indicate a need for programs designed to increase physical activity of adults with mental retardation who reside in community settings (Cook et al., 1997; U.S. Department of Health and Human Services, 1996). Overall, adults with and those without mental retardation need to increase their weekly physical activity levels and would likely improve their health by participating in physical activity regularly (U.S. Department of Health and Human Services, 1996).

The need for physical activity programs is further supported by the low prevalence of adults with mental retardation participating in the recommended frequency of physical activity. Current recommendations indicate that every person should engage in 5 or more bouts of LTPA per week to lower their risk for coronary heart disease, stroke, and obesity (Pate et al., 1995; U.S. Department of Health and Human Services, 1996); however, less than 46% of the men and women with mental retardation in the present study did so.

Even more interesting is the extremely low prevalence of men (1.3%) and women (1.4%) participating in regular vigorous LTPA. Such activity appeared to be nonexistent in adults with mental retardation over 30 years of age; no men or women in this age group reported this amount of activity. Even though participation in regular vigorous LTPA is typically lower in older adults without mental retardation (Crespo et al., 1996), we did not expect that all older adults would report no regular vigorous LTPA.

The findings of a report of high participation in optional, lower intensity (moderate) physical activity programs for adults with mental retardation (Stanish, McCubbin, Draheim, & van der Mars, 2001) combined with the low prevalence of men and women with mental retardation participating in regular vigorous LTPA in the present study, support the fact that adults with mental retardation may choose to participate in less intense, more palatable physical activities rather than more intense, vigorous physical activities. When considering that there may be greater adherence to less intense (moderate) LTPA programs and that adults with mental retardation who participate in the recommended frequency of LTPA are less likely to possess elevated risk factors for cardiovascular disease (Draheim, Williams, & McCubbin, 2002), the recommendation has been made that adults with mental retardation residing in community settings participate in moderate intensity physical activity programs. Physical activity programs for adults with mental retardation residing in community settings should focus on providing and encouraging participation in physical activity five or more times per week to reduce the risk for coronary artery disease, stroke, and obesity (U.S. Department of Health and Human Services, 1996). Participation in social activities may also be related to health benefits for adults with mental retardation, which supports the premise that social activities should also be considered for activity programs (Fujiura, Fitzsimons, Marks, & Chicoine, 1997).

The two most frequently reported activities, walking and cycling, for both men and women participating in the present study likely represent their primary source of transportation. Due to the seasonal weather variations, the frequency of walking, cycling, and other physical activities reported might differ during winter or summer months, when certain activities may not be available (Cook et al., 1997). The frequency of physical activity reported during the summer and early fall (of the present study) might not represent the frequency of physical activity during the winter and spring months and may be an overestimation of the overall yearly frequency of physical activity. Also, the frequency of physical inactivity reported during the summer and early fall (of the present study) might not represent the frequency of physical inactivity during the winter and spring months and may be an underestimation of the overall yearly frequency of physical inactivity.

We can only speculate why individuals chose to participate in the physical activities reported. It is not known whether this form of participation was due to greater desire to participate in the specific physical activities or simply because of availability. An important component of successful physical activity programming for adults with mental retardation would be incorporating activities that are highly enjoyable and would likely facilitate continued participation (Rimmer, 2000). The long list of physical activities reported by the adults in the present study along with the differences in the rank of specific physical activities they reported support the fact that adults with mental retardation are willing to participate in a variety of physical activities. We recommend that a variety of physical activities be implemented in future physical activity programs intended for adults with mental retardation residing in community settings. Future researchers should investigate the adherence to exercise programs incorporating various physical activities and examine the adherence to physical activity programs with activities that adults with mental retardation would likely enjoy and continue to participate in. As physical activity preferences may differ for individuals with different backgrounds and for those in different geographic areas (Crespo et al., 1999), new programs will probably need to be tailored specifically to the ethnic make-up and geographic location of the participants. Future physical activity programs may be more successful if they fill gaps in unavailable, but desired physical activities (Rimmer, 2000).

The ability to generalize the results of the present study may be limited, and caution should be used when interpreting the findings. The participants were not randomly selected, but volunteered. There could be significant selection bias associated with recruiting volunteers for a research project because individuals who are likely to volunteer may be more or less physically active than those who do not volunteer. Furthermore, the sample of the present study included a higher proportion of adults with Down syndrome than the naturally occurring prevalence for all adults with mental retardation in the United States population and may bias the results. However, when considering that the prevalence of recommended frequency of physical activity and physical inactivity did not differ between adults with and those without Down syndrome, the potential selection bias due to the elevated proportion of adults with Down syndrome is likely minimal.

Because the prevalence of reported physical activity and the specific activities of the present study may be specific to the Northwest United States (Cook et al., 1997), the ability to generalize the current results to adults with mental retardation residing in other areas throughout the United States and other countries may be limited. The data collection was conducted during the summer and early fall months, when physical activity habits likely differ from those occurring during the colder and rainier seasons (Cook et al., 1997).

The validity of conducting the physical activity questionnaires with the assistance of careproviders has not been evaluated. However, the regular daily and weekly physical activity routines of adults with mental retardation residing in community settings, along with the additional input of careproviders who often assist with daily activity schedules, has likely produced accurate physical activity information. The estimated energy expenditures from the Ainsworth Compendium for Physical Activity (Ainsworth et al., 1993) may have overestimated the intensity of the specific physical activities reported by the adults with mental retardation or careproviders in the present study. The compendium was not designed for use in populations with mental retardation, but it is the most comprehensive coding system designed to estimate intensity levels of reported activities and is recommended for use to standardize intensity levels for potential comparisons across studies (Ainsworth et al., 1993). The intensity levels of adults with mental retardation who participate in community-based physical activity programs typically are lower than what is needed to elicit increases in cardiovascular fitness (Pitetti et al., 1989). Furthermore, the definition of recommended physical activity used in the present study only includes the recommended frequency of moderate to vigorous physical activity and did not include the recommended duration of physical activity. An accumulation of at least 30 minutes of moderate to vigorous physical activity is recommended (Pate et al., 1995; U.S. Department of Health and Human Services, 1996). The duration was not recorded for the present study and was not used to calculate the recommended frequency of physical activity in the present study. The inclusion of shorter bouts (less than 30 minutes) of physical activity may have overestimated the prevalence of recommended frequency of physical activity. An overestimation of physical activity frequency or intensity in the present study may have resulted in an overestimation of the prevalence of adults with mental retardation participating in the recommended frequency of physical activity (Pate et al., 1995; U.S. Department of Health and Human Services, 1996). More expensive, elaborate, and time-consuming methods to quantify physical activity, such as using pedometers, accelerometers, or direct observation could have resulted in more accurate estimates of physical activity levels.

Though still low, the prevalence of recommended weekly frequency of physical activity reported in the present study (42% to 47%) was considerably higher than what has been reported for adults without mental retardation (< 23% to 24%) (U.S. Department of Health and Human Services, 1996). As discussed above, the higher prevalence of the recommended frequency of physical activity may be due to an overestimation of the recommended physical activity for adults with mental retardation. Also mentioned above, walking and cycling, the two most prevalent activities, are likely the main forms of transportation for this population and may also contribute to more adults with mental retardation reporting more frequent bouts of physical activity than adults without mental retardation, who likely use walking and cycling less often for their main modes of transportation.

The elevated mean BMI reported for men and women in the present study may support the argument that recommended physical activity levels were overestimated in the present study. However, previous reports have indicated that physical activity was not significantly associated with BMI (Fujiura et al., 1997) or abdominal obesity (Draheim et al., 2002b) in adults with mental retardation. Conversely, dietary fat intake was associated with abdominal obesity in these adults (Draheim et al., 2002b) and may be the one of the main contributors to elevated BMI levels in adults with mental retardation in the present study. Supporting the possible role of dietary fat contributing to obesity in adults with mental retardation is the finding that over 93% of adults with mental retardation residing in community settings consume over the recommended dietary fat intake (Draheim, Williams, & McCubbin, 2002).

In summary, the present findings represent the first prevalence estimates of physical inactivity and prevalence estimates of the recommended frequency of physical activity for adults with mild to moderate mental retardation, with or without Down syndrome residing in community settings. Overall, they were similarly inactive, with a low prevalence of individuals participating in the recommended frequency of LTPA and an extremely low prevalence participating in regular vigorous LTPA. The top two most frequently reported activities by both men and women were walking and cycling, which likely represent modes of transportation. Participation in over 20 activities were reported, indicating a variety of activities, which included team sports, individual activities, recreational activities, and even rock-climbing and horseback-riding. Future physical activity programs should be focused on providing a variety of physical activities and encouraging participation in moderate intensity physical activity five or more times per week.

Note: This study was supported by the John C. Erkkila, MD, Endowment for Health and Human Performance; the Arc of Washington Trust Fund; the U.S. Department of Education, Leadership Training Grant, Contract H029D70026; and the National Institute on Disability and Rehabilitation Research, Contract H133P000005. The authors thank Jessica Jacks for her technical assistance during the data collection.

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Author notes

Authors: Christopher C. Draheim, PhD, Instructor, Division of Kinesiology, University of Minnesota, 27T URC, 1900 University Ave. SE, Minneapolis, MN 55455 ( draheim@umn.edu). Daniel P. Williams, PhD, Assistant Professor, The University of Utah, College of Health, Department of Exercise and Sport Science, 250 S. 1850 E., HPER North, Rm. 256 ( daniel.williams@hsc.utah.edu). Jeffrey A. McCubbin, PhD, Professor, Associate Dean, College of Health and Human Sciences, Department of Exercise and Sport Science, Oregon State University, 123 WB, Corvallis, OR 97331-6802 ( jeff.mccubbin@oregonstate.edu)