Exercise as it relates to Disease/Enhancing health and well being: physical activity and nutrition in children and youth with intellectual disability and autism

Enhancing health and well being: physical activity and nutrition in children and youth with intellectual disability and autism.
This is an analysis of the journal article "Physical activity, dietary habits and overall health in overweight and obese children and youth with intellectual disability or autism" by Hinckson, Dickinson, Water, Sands and Penman (2013).

What is the background to this research?
Children and young people with intellectual and developmental disabilities and impairments, such as Autism Spectrum Disorders (ASDs), have been found to have a higher prevalence of obesity and physical inactivity when compared to their peers without disability. These children and young people are also less likely to partake in continuous robust physical activity and may find it difficult to engage in activities of daily living (ADLs) or participate in team sports, preferring independent physical activities like swimming and cycling. Overweight and obesity in children and young people with intellectual disability and ASDs has been linked to medication use, low levels of physical activity, poor nutrition, lack of health literacy or awareness, inappropriate behaviours relating to their condition and other related chronic health conditions and metabolic abnormalities, as well as environmental factors. Obese and overweight children with disabilities therefore have an increased risk for developing chronic diseases associated with these health conditions.

Where is this research from?
This study was carried out by researchers from the Centre for Child Health Research, Institute of Public Health and Mental Health at the Auckland University of Technology and the Auckland District Health Board Health and Disability Services with children and youth at risk of obesity in two special needs schools in Auckland, New Zealand. The article was published by Elsevier Incorporated and the researchers obtained ethics approval from New Zealand’s regional ethics committee. Consent and assent, where achievable, was obtained. Although this study was conducted in New Zealand, other Western nations including Australia may find the results relevant.

What kind of research was this?
This study was a single group, pre- and post-test experimental research design. Pre- and post-test designs are used to test the effectiveness of an intervention where participants act as their own controls and their outcomes before the interventions are compared to their outcomes after the intervention. Pre- and post-test experimental groups are generally compared to a control group so comparisons can be made at the checkpoints. As this study was run without a parallel control group, it is difficult to determine if the intervention was solely responsible for the changes that were observed. It is also much harder for researchers to control for confounding factors, such as sampling or maturation bias, a major weakness to this research design choice.

What did the research involve?
Complete data was gathered from 17 participants (10 males, 7 female), between the age of 7 and 20 years old. A 10-week program consisting of 18 sessions, each two-hours long, was implemented and involved a physical activity component for the first hour with students and their parents/caregivers, followed by an active session for students while parents/caregiver’s attended information sessions on nutrition or motivational skills. Data was collected prior to the commencement of the program, at the end of the 10 weeks, and at follow-up 24 weeks post-program. Quantitative data was collected through the use of a modified Mind, Exercise, Nutrition… Do it! (MEND) questionnaire completed by parents/caregivers at each measurement point, the six-minute walk-test (6MWT) and measurements of height, weight, body mass index (BMI) and circumference. Qualitative data was collected from semi-structured interviews with teachers, parents or caregivers and program providers.

Research limitations included:
 * Small sample size
 * No control group – researchers are therefore unable to detect if changes were due to intervention alone
 * Use of self-report questionnaires – people are more likely to under or over report or report desirable answers
 * Proxy reporting used to report behaviours in children and youth – prone to over-and under-estimation of behaviours
 * While modified, the MEND questionnaires are not validated for children with intellectual disabilities or autism
 * Measurements were taken in different seasons – baseline measurements were conducted in summer whereas the end of the 10 weeks and at 24 weeks follow-up, measurements were conducted in winter when the weather might have had an effect on physical activity levels

What were the basic results?
The basic results showed that the only measurable change occurred in the 6MWT, where at 24 weeks post-program participants were able to talk 51m further. Parents/caregivers reported confidence in their child’s abilities to manage healthy lifestyle choices, substantial reductions in consumption of confectionery and chocolate at post-program and 24-weeks follow-up, fewer hospital visits and illness-related absences from school. Common themes to emerge from interviews included health gains, social gains and goodness of fit of the program to the needs of the children and young people as participants were perceived to be more active and more aware of healthy food choices.

What conclusions can we make?
This study suggests that for children and youth with intellectual disabilities or autism, engagement and support in physical activity and nutrition programs modified to suit their needs helps to increase independence, participation in physical activity and knowledge of health and nutrition. This study helps to inform the future development of combined nutrition, physical activity and weight management programs for children and youth with intellectual disabilities or autism. Researchers recommend that the development of future programs focus more holistically on healthy living rather than weight management.

Practical advice
For children and young people with intellectual disabilities or autism, it would be of benefit to focus on creating healthy habits and living healthier lifestyles rather than weight management and incorporate activities the child or young person can gain confidence in, engages with or finds meaning in when participating.