The walking activity of men and women with mental retardation residing in community settings was described. Participants were 38 women (M age = .7, SD = 9.5) and 65 men (M age = 35.9, SD = 11.2). They wore pedometers for 7 days. A 2 × 2 factorial ANOVA indicated no significant gender differences in total step counts or between participants with and those without Down syndrome. A post-hoc analysis revealed that participants walked less on Saturday than during the weekdays. Only 21.1% of the women and 21.5% of the men with mental retardation accumulated the recommended 10,000 steps per day.
This research was funded by the Canadian Institute of Health Research (university seed grant) and by the St. Francis Xavier University Council for Research. The authors thank all participants and caregivers for the time and effort they dedicated to this project. Also, we acknowledge the contributions of Sarah Bayne and Krista Pitcher, who assisted greatly with data collection.
Walking is one of the most common leisure time physical activities performed by adults (Crespo, Keteyian, Heath, & Sempos, 1996). Public health initiatives aimed to promote active living often emphasize walking (Pate et al., 1995; U.S. Department of Health and Human Services, 1996). For example, a 10,000 steps/day target has been promoted by Japanese researchers (Yamanouchi et al., 1995) and may be similar to the Surgeon General's recommendation of 30 minutes per day of physical activity (U.S. Department of Health and Human Services, 1996). Although researchers have only begun to examine the validity of the 10,000 steps/ day goal for the general public (Le Masurier, Sidman, & Corbin, 2003; Swartz et al., 2003; Welk et al., 2000; Wilde, Sidman, & Corbin, 2001), it is the most widely publicized walking target to date. A number of substantial initiatives in Canada and the United States have aimed to increase the amount of walking performed by the population through using pedometers to measure and promote step counts. America on the Move (The Partnership, n.d.) and Steps to a Healthier US (U.S. Department of Health and Human Services, n.d.) are examples of strategies that employ goal setting and pedometers to encourage individuals to walk more. Studies suggest that regular brisk walking is comparable to vigorous exercise in terms of reductions in the risk and incidence of coronary events (Manson et al., 1999; Murphy, Nevill, Neville, Biddle, & Hardman, 2002). As a result, there is a trend to use pedometers to monitor walking as a contributor to overall physical activity.
It has been repeatedly demonstrated that adults with mental retardation have elevated risk factors for coronary heart disease and stroke (Draheim, McCubbin, & Williams, 2002; Draheim, Williams, & McCubbin, 2002a; Rimmer, Braddock, & Marks, 1995; Wells, Turner, Martin, & Roy, 1997). The poor cardiovascular health of individuals with mental retardation may be partly attributed to the low physical activity levels found in this segment of the population (Beange, McElduff, & Baker, 1995; Draheim, Williams, & McCubbin, 2002b; Messent, Cooke, & Long, 1998; Rimmer et al., 1995). Although activity levels are typically low, walking is one of the most frequently reported physical activities by individuals with mental retardation. Temple, Anderson, and Walkley (2000) found that all adults with mental retardation in their study gained some moderate intensity physical activity from walking for transport. Even those participants who performed very little moderate intensity physical activity accumulated considerable minutes per day walking, although intensity was low. Draheim et al. (2002b) found that less than 46% of participants achieved current physical activity recommendations in the United States (U.S. Department of Health and Human Services, 1996). However, 54% of males and 56.8% of females reported walking. Walking and cycling were the most frequently reported activities and likely represented primary sources of transportation. The walking habits of individuals with mental retardation have received little attention from researchers, even though walking likely contributes to overall physical activity levels.
The digital pedometer has become a popular instrument for monitoring walking activity. Pedometers are able to count steps and measure distance walked; some models can provide an estimate of caloric expenditure. However, pedometers do not measure the duration or intensity level of an activity. Pedometers are widely used in research and their validity and reliability has been repeatedly established (Bassett et al., 1996; Bassett, Cureton, & Ainsworth, 2000; Leenders, Sherman, & Nagaraja, 2000; Tudor-Locke, 2001; Tudor-Locke, Williams, Reis, & Pluto, 2002). Although many researchers have used pedometers to examine the walking habits of the nondisabled population (Sequeira, Rickenbach, Wietlisbach, Tullen, & Schutz, 1995; Tudor-Locke et al., 2001; Welk et al., 2000; Wilde et al., 2001), there are only two studies in which researchers have used pedometers to describe the walking habits of individuals with mental retardation. Suzuki et al. (1991) examined the walking activity of children with mental retardation (age 6 to 18 years) for 6 days and reported mean pedometer values of 16,000 and 12,300 steps/day for males and females, respectively. Stanish (2004) used pedometers to describe the daily walking activity of 20 adults with mental retardation across 7 consecutive days. The female participants walked an average of 10,811 steps/day whereas the males accumulated 7,863 steps/day; gender differences were not significant. Results also indicate that adults with Down syndrome walked significantly less than those without Down syndrome.
More information about the walking habits of adults with mental retardation could provide insight into the overall physical activity habits of this segment of the population. In addition, the information could assist in setting challenging but attainable goals for walking programs at work and in the community. The only published study using pedometers in adults with mental retardation (Stanish, 2004) was a preliminary investigation designed to examine the accuracy of pedometers in adults with mental retardation and gather some initial data on walking habits. A small sample (n = 20) of participants from one rural town in Eastern Canada were studied. In the present investigation our aim was to provide additional knowledge about the walking habits of adults with mental retardation by using a considerably larger sample that contained participants from both urban and rural areas. It is important that further data are gathered using pedometers in this segment of the population to provide accurate information about walking habits. Therefore, our main objective was to examine the daily walking habits of adults with mental retardation and to determine whether differences exist between genders.
Participants were 103 adults (38 females, 65 males) with mild or moderate mental retardation. They ranged in age from 19 to 65 years (Ms = 39.7 [SD = 9.5] and 35.9 [SD = 11.2] for females and males, respectively). Nineteen of the participants had Down syndrome (9 females, 10 males). All were volunteers who were recruited through organizations and service providers associated with people who have mental retardation (e.g., residential services, community workshops, Special Olympics). Forty-one participants resided in a small option home (residential placement for 1 to 3 people homes); 14, in group homes; 26, at home with family; 17, semi/independently; and 5, in an institution.
Participants signed a simply worded consent form that was read to them if they were unable to read. A caregiver signed the form if a participant was unable to provide their own consent. All procedures were approved by a University Ethical Review Board for the Protection of Human Subjects prior to data collection.
Assessment of Walking Habits
Yamax Digiwalkers (SW-500 and SW-700) were used to record step counts. There is supportive evidence that the Yamax Digiwalker is one of the most accurate pedometers available (Bassett et al., 1996). Further, Yamax Digiwalkers have proven accurate and reliable for counting steps in people with mental retardation (Stanish, 2004).
Depending on the intellectual capacity of the participant, either the participant or a caregiver was instructed on how to use the pedometer, which was attached to a belt or waistband and placed approximately in line with the middle of the thigh according to the manufacturer's instructions. Participants were asked to reset the pedometer in the morning and to record step counts and distance at the end of the night. They were instructed to wear the pedometer from the time that they got up in the morning until bedtime for 7 days, except during swimming or showering. All participants, caregivers, and employment supervisors were informed that the pedometer counted steps and were asked not to tamper with the device so as not to inflate step counts or accidentally reset the counter.
Height, Weight, and Body Mass Index
Weight was measured to the nearest kilogram on a digital scale with the participant wearing lightweight clothing. Height was measured to the nearest 0.1 cm with a wall-mounted measuring tape. Body mass index (BMI) was calculated by dividing the weight in kilograms by the height in meters squared.
The means and SDs were calculated for age, height, weight, BMI, total weekly step counts, and step counts for each day of the week for all participants. Independent t tests were conducted to determine whether step counts differed between men and women for weekly step counts and step counts for each day of the week. Because a preliminary analysis indicated there were no differences between persons with and without Down syndrome, between residential settings, and between genders (except for Tuesdays), a repeated measures ANOVA was conducted on all participants to determine whether there were differences in step counts for each day of the week. We used an LSD post-hoc analysis of the repeated measures ANOVA to determine specifically which days differed. The prevalence of men and women who recorded an average daily step count of 10,000 steps or more was calculated as percentages. Chi-square analysis was calculated to determine whether the prevalence of persons recording an average daily step count of 10,000 steps or more differed between men and women.
The mean age, height, weight, and BMI along with SDs are presented in Table 1 for men and women. The men were significantly taller than the women, p = .000, and the women had significantly higher BMI values, p = .002. Table 2 contains the means and SDs for the weekly and daily step counts for men and women. The weekly and daily step counts did not differ between men and women except on Tuesdays, p = .031.
The daily step counts for the entire group included the following steps per day (M ±SD): Monday (7,713 ± 5,211), Tuesday (8,511 ± 6,471), Wednesday (9,548 ± 9,865), Thursday (8,176 ± 5,947), Friday (8,456 ± 5,579), Saturday (6,590 ± 4,652), and Sunday (5,828 ± 4,598). The step counts differed significantly among days of the week, F(6,714) = 313.78. The LSD post-hoc analysis indicated that the total group walked less on Saturday, ps < .000 to .009, and Sunday, ps < .000 to .004, than during each of the weekdays except Monday. The steps recorded on Saturday and Monday did not differ. The steps recorded on Saturday and Sunday did not differ nor did those recorded on each of the weekdays. Only 21.1% of the women and 21.5% of the men with mental retardation recorded the recommended 10,000 steps per day, which did not differ between men and women.
Although only about 21% of adults with mental retardation achieved the 10,000 steps/day target, participants did accumulate similar daily step counts to those reported for the general population. The reported values in the range of 6,000 to 11,000 steps/day (Bassey, Dallosso, Fentem, Irving, & Patrick, 1987; Chan, Spangler, Valcour, & Tudor-Locke, 2003; Sequeira et al., 1995; Tudor-Locke, Jones, Myers, Patterson, & Ecclestone, 2002; Wilde et al., 2001), are similar to the overall average (approximately 7,700 steps/day) in the present study. Tudor-Locke and Bassett (2004) provided evidence that approximately 6,000 to 7,000 steps/day is indicative of typical daily activity, excluding sport and exercise, although 9,000 to 11,000 steps/day is closer to current physical activity guidelines. Therefore, some of the participants in the present study could be considered physically active based on their step counts. Walking likely represents the primary mode of transportation for adults with mental retardation and, thus, it is not surprising that they accumulated similar values to the general population. Also, employment tasks are frequently physical in nature and require some walking, which may have contributed to the overall step counts. Although the walking activity in the present study was comparable to the general population, the elevated mean BMIs reported for men (28.8, SD = 6.0) and women (34.9, SD = 14.6) in this study may suggest that the participants were not achieving the benefits to body composition known to be associated with walking.
Although researchers investigating the nondisabled population has reported gender differences in physical activity (Crespo et al., 1996), the daily and weekly step counts for men and women in this sample were not significantly different. Stanish (2004) found no gender differences in a previous study on walking activity in adults with mental retardation. Draheim et al. (2002a) also reported that the men and women with mental retardation in their study were similarly inactive. It appears that men and women with mental retardation have similar physical activity patterns that may be a result of a lifestyle that is typically very structured.
The average step counts for males were consistent with those recorded in a previous study on adults with mental retardation (Stanish, 2004), whereas the average female steps counts were considerably lower in the present study. It is possible that Stanish's earlier study included a group of female volunteers that walked more than a typical adult female with mental retardation. Because both samples were nonrandom, it is difficult to conclude which results are more characteristic of the population. However, the current study included three times as many females as has been the case in previous investigations; so the results would seem more representative of the population.
The significant difference between walking activity on Saturday and Sunday compared to the weekdays is an indication that participants accumulate a considerable number of steps as part of transportation to and from work. Further, it is likely that many of the participants worked at jobs that required physical tasks and walking (e.g., window washing, woodworking shop, trash collection). A previous study on walking activity also revealed that adults with mental retardation walked more on weekdays (Stanish, 2004). Messent et al. (1998) reported that nearly all participants with intellectual disabilities spent the entire weekend at home (with parents or in a residential setting). The lower walking levels observed on the weekends may also be indicative of the participants choosing to do less active recreational activities in general on weekends.
The ability to generalize the results of this study may be limited and caution should be used when interpreting the findings. The participants were not randomly selected, but volunteered. It is possible that a volunteer may be more or less physically active than individuals who did not volunteer. Furthermore, the activity habits of our participants may be specific to Eastern Canada, and generalizing the current results to adults with mental retardation residing in other areas of North America and other countries may not be accurate. Further, the data collection was conducted during the summer and early fall months, when physical activity habits likely differ from the physical activity habits during the colder and rainier seasons (Cook et al., 1997).
In summary, the findings of the present study represent the second estimates of daily and weekly walking activity for men and women with mild to moderate mental retardation residing in community settings. In this study we have built on a preliminary investigation through examining a larger sample from a broader geographical area. Overall, the men and women accumulated similar step counts per day and per week. Although a low percentage of the participants actually achieved the widely publicized 10,000 steps/day target, the average daily step count of the sample reflects typical daily activity according to a recent publication (Tudor-Locke & Bassett, 2004). Because the validity of the 10,000 steps/day target has only been empirically examined in a few studies, it should not necessarily be the criterion to which the results of the present study be compared. Our objective was to describe the typical walking activity of adults with mental retardation. At most, a popular activity target can be used as a point of reference. In the earlier study, 45% (9 of 20) of participants accumulated an average of 10,000 steps/day (Stanish, 2004). The difference in results may be partly explained by the fact that the previous data were collected in a small town with no public transportation system. Participants may have had to rely on walking more as a result. The small sample in the previous study may also have been more homogeneous and represented an especially active group of individuals with mental retardation. Because age and BMI were not notably different among the studies, it is unlikely that those variables could account for the differences.
Walking and cycling are the most commonly reported physical activities for persons with mental retardation (Draheim et al., 2002; Temple et al., 2000), and programs should focus on these activities to promote healthy lifestyles. If given the opportunity, many adults with mental retardation will voluntarily participate in moderate intensity physical activities (Stanish, McCubbin, Draheim, & van der Mars, 2001). Therefore, families, residential staff, and employment supervisors may work towards developing programs focused on walking and other moderate intensity activity on weekends and weekdays in order for adults with mental retardation to gain health benefits.
Authors: Heidi I. Stanish, PhD, Assistant Professor (firstname.lastname@example.org), Department of Exercise Science and Physical Education, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA, 02125-3393; also affiliated with St. Francis Xavier University. Christopher C. Draheim, PhD, Assistant Professor, Department of Exercise and Sport Science, 123 Women's Building, Corvallis, OR 97331-5109