SULLIVAN TU DOT EBP review 2012

1Running Head: PHYSICAL ACTIVITY PROGRAMS 1

The Effectiveness of Physical Activity Programs in Promoting Weight-Loss in

Obese Adults with Intellectual and Developmental Disabilities

Allison Sullivan

Temple University

Physical Activity Programs 2

The Effectiveness of Physical Activity Programs in Promoting Weight-Loss in Obese Adults

with Intellectual and Developmental Disabilities

Obesity is a national epidemic. According to the Centers for Disease Control and

Prevention (CDC), obesity is “common, serious, and costly”, with over one-third of adult

Americans meeting the body mass index (BMI) criteria for this term (U. S. Department of Health

and Human Services, 2001). Heart disease, stroke, diabetes, and some cancers are obesity-related

conditions that the CDC considers some of the leading causes of preventable deaths. Substantial

evidence exists to support the understanding that sedentary lifestyle is one of the most significant

risk factors for obesity and one that can be successfully modified (U. S. Department of Health

and Human Services, 2001). In light of these findings, numerous public health organizations and

agencies such as the CDC (2001), the U.S. Office of the Surgeon General (2002) and the U. S.

Department of Education, National Institute on Disability and Rehabilitation Research-Research

Projects and Centers Program; Funding Priorities (2006) have sponsored a variety of initiatives

to promote increased physical activity in the population.

As Stewart, et al. noted (2006), “Evidence for the effectiveness of community-level

intervention to increase adult physical activity (PA) was reviewed by the Task Force on

Community Preventive Services. Two “strong” recommendations were individually adapted

health behavior-change programs and creating or improving access to places for PA, particularly

in neighborhoods with the least resources... Individually tailored PA programs and interventions

that include principles of behavior change were also featured in the recent Best Practices

Statement for promoting PA in older adults developed by a coalition of national organizations

led by The American College of Sports Medicine. Many initiatives emphasize the need to


increase PA in underserved populations… primarily because these groups are at higher risk of

poor health and have lower levels of PA than their counterparts”.

A vast amount of research exists on the subject of obesity, sedentary lifestyle, and

appropriate methods for addressing these issues. There is so much research, in fact, that it is

supremely challenging for any researcher investigating this topic to begin the process of

critically appraising the quality of this body of evidence. The results reported in this literature

can be of a contradictory nature. Many studies promote changes in dietary habits, for example,

while other investigations assert that efforts to change the dietary habits of underserved groups,

as well as within the population at large, is challenging and unsuccessful in the long-term due to

limitations with resources and issues of self-determination (Bazzano et al., 2009; Ewing, et al.,

2004; Chapman, et al., 2008; Heller et al., 2004)

A number of different techniques have been researched for the purposes of effecting

weight-loss in the general population. Health education programs, nutrition counseling, gastric

bypass surgery, resistance training programs, group exercise classes such as Zumba, mall

walking programs, and interval training programs have all been identified as methods to promote

weight loss.

One group in particular that faces multiple challenges in addressing the health-related

risks of sedentary lifestyle are adults with intellectual and developmental disabilities. Adults with

these disabilities are more likely to be people with low socioeconomic status and have neither the

means nor the capability to access places for physical activity independently. Many individuals

with these conditions require assistance with everyday life skills (Bazzano et al., 2009;

Chapman, Craven, & Chadwick, 2005; Chapman, Craven, & Chadwick, 2008; Ewing,

McDermott, Thomas-Koger, Whitner, & Pierce, 2004; Heller, Hsieh, & Rimmer, 2004;


Marshall, McConkey, & Moore, 2002; Melville, et al., 2011; Saunders, et al., 2011). A large

percentage of people with developmental or intellectual disabilities live in community

residences, and staffs at these residences often have limited means or understanding regarding

healthy meal preparation. According to Elinder, et al, (2010), “People with intellectual

disabilities are more likely to have poor dietary habits, low physical activity, and weight

disturbances”. A report by Bazzano, et. al. (2009), notes that people with intellectual and

developmental disabilities have more chronic disease conditions than that of the general

population, and are thus more costly to treat over their lifespan that members of the population at

large. Although a significant amount of research exists on obesity and interventions designed to

promote weight loss, very little research has been conducted to date to identify those

interventions that most effectively promote weight loss in this vulnerable group (Bodde, 2012,

Melville, 2011).

As stated by the World Health Organization (WHO), “Physical activity is defined as any

bodily movement produced by skeletal muscles that requires energy expenditure” (2009).

Physical activity as an intervention is used to “promote weight loss and reduce or prevent the

chronic complications of obesity” (Bazzano, et al., 2009). Increased physical activity has been

shown to be an effective method for promoting weight-loss in obese adults (U. S. Department of

Health and Human Services, 2001).

Thus, an evidenced-based practice review was conducted to investigate the effectiveness

of research-based exercise programs in effectively promoting weight loss or slowing weight gain

in adults with intellectual and developmental disabilities. Activity programs that promote weight

loss were chosen as the intervention under investigation because adults with developmental

disabilities are at high risk for obesity and related health problems. Physical activity level and


obesity are risk factors for chronic health conditions such as heart disease, diabetes, and cancer

that can be modified, and interventions which target these risk factors may be one significant

approach toward improving health in this population (U.S. Office of the Surgeon General, 2002).

Methodology

An evidence based practice review was conducted to explore the question, “What are the

effective exercise or activity-based interventions for promoting weight loss or preventing weight

gain in obese or overweight adults with intellectual or developmental disabilities?”

Participants

Participants in the included studies ranged in age from 18 to 71 years old (Bazzano et al.,

2009; Chapman, Craven, & Chadwick, 2005; Chapman, Craven, & Chadwick, 2008; Ewing,

McDermott, Thomas-Koger, Whitner, & Pierce, 2004; Heller, Hsieh, & Rimmer, 2004;

Marshall, McConkey, & Moore, 2002; Melville, et al., 2011; Saunders, et al., 2011). One study

included obese or overweight participants specifically diagnosed with Down syndrome (Heller,

et al., 2004). Two studies included the same participants but reported on findings from different

points in the study period (Chapman, et al., 2005; Chapman, et al., 2008). It should be noted,

however, that although these two studies explicitly stated that the same participants were used in

both studies, in the first study the authors utilized the term “learning disabilities” to describe the

disabling condition of the participants, while in the 2008 study, the same authors used the term

“intellectual disabilities” to describe the disabling condition of those participants.

In addition to the Chapman, et al. study from 2008, two studies included obese or

overweight participants with identified “intellectual disabilities” (Marshall, et al., 2002; Melville,

et al., 2011). One study included obese participants identified with “intellectual or developmental

disabilities” (Saunders, et al., 2011). One study compared results of what the authors described


as “normal learners” to that of “individuals with mental retardation” (Ewing, et al., 2004). One

study included obese or overweight participants with identified “developmental disabilities”.

Interventions

All of the studies included a nutritional education component (Bazzano, et al, 2009;

Chapman, et al. 2005; Chapman, et al., 2008; Ewing, et al., 2004; Heller et. al, 2004; Marshall, et

al., 2002; Melville, et al., 2011; Saunders, et al., 2011). None of the studies measured physical

activity without a dietary intervention component (Bazzano, et al, 2009; Chapman, et al. 2005;

Chapman, et al., 2008; Ewing, et al., 2004; Heller et. al, 2004; Marshall, et al., 2002; Melville, et

al., 2011; Saunders, et al., 2011). Two of the studies provided both nutrition and exercise

information as well as supervised physical activity in a group format (Bazzano, et al., 2009;

Heller et al. 2004). One study provided exercise and nutrition education in a group format with

an optional recommended group walk (Ewing, et al., 2004). One study consisted exclusively of

group education sessions, while “emphasizing the importance of exercise” (Marshall, et al.,

2002). Four studies utilized individualized diets and exercise programs with home visit education

sessions and data collection tasks, but no supervised exercise component (Chapman, et al. 2005;

Chapman, et al., 2008; Melville, et al., 2011; Saunders, et al, 2011).

Outcome Measures

There were a variety of outcomes measures employed to examine the effectiveness of the

interventions used. Four studies used Body Mass Index (BMI) and weight lost (Bazzano, et al.,

2009; Marshall, et al., 2002; Melville, et al., 2011; Saunders, et al. 2011). The Bazzano, et al.,

2009 study also included self- reported nutrition, physical activity, and life satisfaction measures.

The Melville, et al., 2011 study included measures of physical activity and sedentary behavior in

addition to BMI and weight lost.


The two studies that were a longitudinal comparison of the same subjects used BMI

exclusively (Chapman, et al. 2005; Chapman, et al, 2008). One study used BMI in addition to

pre and post -test measures of knowledge of healthy eating choices (Ewing, et al, 2004). One

study used Likert scales for rating health status and Instrumental and Activities of Daily Living

Scales completed by a guardian, as well as self-report measures including the Cognitive-

Emotional Barriers to Exercise Scale, Exercise Perception Scale, a non-standardized measure of

self-efficacy, Life Satisfaction Scale, and an adapted Children’s Depression Inventory (Heller,

et. al, 2004). This study did not report on BMI or weight loss as an outcome measure of the

study.

Search Strategies

Relevant research articles were identified via computer-assisted search of online

databases. The following search terms and key words were utilized in various combinations:

intellectual disabilities, developmental disabilities, obesity, weight gain, exercise, physical

activity, and intervention. Search terms that were combined to yield significant results included:

(intellectual or developmental) and disabilities, obesity or weight gain, and exercise or physical

activity; and (intellectual or developmental) and disabilities, obesity or weight gain, exercise or

physical activity, and intervention. The electronic databases that were searched included

Academic Search Premier, CINAHL with Full Text, Health Source: Nursing/Academic Edition,

MEDLINE, OT Search, PsycARTICLES, Psychology and Behavioral Sciences Collection, and

PsycINFO. The online search yielded 15 studies, seven of which were included for review. A

citation review was conducted by hand after the articles from the database search were obtained,

and one additional study was located via this hand search.


Inclusion and exclusion criteria for the search

Research articles published after 2002 were included in the review. All studies included

explored aspects of physical activity as an intervention. Due to the very limited number of

published studies in this area, studies with combined interventions were included. Studies that

reported adult subjects with overweight and obese body mass index were included in the review.

Literature had to be published in English to be included. Studies that were exclusively

correlational or descriptive in nature were excluded from review. Studies that were not

completed on subjects with developmental or intellectual disabilities were excluded. Expert

opinion articles with no sample studied were excluded.

Data collection and analysis

All eight of the studies included in this review used quantitative data to describe their

results. Three of the studies compared experimental groups to control groups (Chapman et al.,

2004; Chapman, et al., 2008; and Heller, et al., 2004). One of the studies was a randomized

control trial (Heller, et al., 2004). Two studies followed a nonrandomized comparison group

design (Chapman et al., 2004; Chapman, et al., 2008) One study utilized a case-controlled,

nonrandomized pretest-posttest design (Ewing, et al., 2004). Four studies followed a single

group, pretest- posttest design (Bazzano, et al., 2009; Marshall, et al., 2003; Melville, et al.,

2011; Saunders, et al., 2011). None of the studies incorporated blinding into the study designs.

One study gathered follow-up data after the completion of the intervention (Melville, et al.,

2011).

The eight studies utilized a variety of methods for analyzing data. Three studies used

Analysis of Covariance (ANCOVA) to test the effects of diet and exercise on weight loss

(Chapman et al., 2004; Chapman, et al., 2008; and Heller, et al., 2004). Four studies employed


paired t-tests to analyze pretest-posttest data group means (Bazzano, et al., 2009; Ewing, et.al,

2004; Marshall, et al., 2003; Melville, et al., 2011). Three studies used McNemar’s test for this

reason as well (Ewing, et al., 2004; Heller et al., 2004; Melville, et al., 2011). Three studies

reported Chi-squared test results to describe the distribution of the sample and detect differences

in the group demographic differences (Bazzano, et al., 2009; Ewing, et al., 2004; Heller, et al.,

2004).

One study used the Wilcoxon Signed Rank Test to analyze some measures of physical

activity for which the distribution was skewed (Melville, et al., 2011). One study employed a

Type III sum of squares as adjusted measures because the number of participants in intervention

and control groups was different (Heller, et al., 2004). This same study also reported the

Cronbach’s alpha reliability to describe the Likert scale measures that were used (Heller, et al.,

2004). One study did not utilize inferential statistics to analyze the data (Saunders, et al., 2011).

This study reported the average percent of weight loss by living arrangement, diagnosis, and

gender for the sample, but did not utilize a statistical package to analyze the results beyond

stating that these results were comparable to the “recommended 7% weight loss by the of the

Diabetes Prevention Program” (Saunders, et al., 2011).

Results

Overall, the research studies in this review display limited effectiveness in their

interventions’ successes in promoting weight loss in adults with developmental disabilities. In

this review, only one randomized controlled trial has been completed to measure the benefits of

an exercise and nutritional education program with adults with Down syndrome, and this

particular study did not investigate the effectiveness of the program in promoting weight loss,

reporting instead on psychosocial factors such as the life satisfaction and sense of self-efficacy of


its participants (Heller, et al., 2009). Since each of the interventions described in this review are

so different from one another, it is very difficult to draw conclusions with any true confidence

regarding the ultimate ability of an exercise-based intervention to promote sustainable weight

loss in adults with intellectual disabilities.

In fact, the two studies by Chapman, et al. (2005 and 2008, respectively) reported on the

same group of participants at one year and at 6 years using this intervention, and demonstrated

diminishing returns over time. Although the amount of weight lost for the intervention group was

significant after one year in the study, after six years of the intervention, the rate of weight loss

for the intervention group was no different from that of the control group.

All of the studies did demonstrate the ability of participants to lose weight during the

study period. With no follow-up data from seven of these studies, however, it is not possible to

determine whether these results were sustainable or whether the techniques used might be

applicable to the population of adults with developmental disabilities at large. (Bazzano, et al,

2009; Chapman, et al. 2005; Chapman, et al., 2008; Ewing, et al., 2004; Heller et. al, 2004;

Marshall, et al., 2002, 2011; Saunders, et al., 2011). Of this group, five of the studies emphasized

diet supervision and encouraged exercise but the exercise component was not supervised by the

study team (Chapman et al., 2005; Chapman, et al., 2008, Marshall, et al., 2003; Melville, et al.,

2011; Saunders, et al., 2011).

Only two of these studies actually provided supervised exercise instruction as a

component of the intervention (Bazzano, et al., 2009; Heller, et al., 2004). One study had a

supervised walking component, but this was optional for participants (Ewing, et al., 2004).

Bazzano, et al. (2009) did demonstrate significant weight loss in 67% of study subjects and both

the Bazzano, et al. (2009) and Heller, et al. (2004) studies showed significant improvements in


participants’ life satisfaction. While these two studies showed promising results for their

participants, they are very small studies completed over fairly short periods of time with no

follow-up and have limited generalizability for these reasons.

Discussion and Clinical Implications

The results of this evidence- based practice review regarding the effectiveness of activity-

based interventions in promoting weight loss in adults with developmental disabilities indicates

that there is still much to be learned about the usefulness and best methods for this type of

intervention with this population. All eight of these studies show that activity can promote

weight loss in adults with intellectual disabilities. Since seven of the eight studies lacked follow-

up data, however, it is not possible to state with confidence whether programs of this nature

produce lasting benefits. Additionally, since the nature and format of each of these interventions

was so vastly different, it is almost impossible to compare them to one another in any way that

allows the critical appraiser to make any generalizations of substance about their results.

Adults with intellectual disabilities are an under-studied group of individuals in our

population. The amount of research regarding exercise with this group is very limited. Further

research is needed to determine whether or not exercise-based interventions can promote weight

loss or prevent weight gain in adults with these disabling conditions.

Implications for Consumers

Activity based interventions for obese adults with developmental disabilities have not

been shown conclusively to promote sustainable weight loss. A healthcare provider may

implement an activity program to promote weight loss, but outcomes are inconsistent. Due to

the many co-morbid health factors associated with obesity and developmental disability, a


caregiver should seek a physician’s advice before embarking on any efforts to promote weight

loss in the individuals under their care, with regard to both diet and exercise guidelines.

Implications for Practitioners

Exercise-based activity programs may promote weight loss and prevent weight gain in

obese adults with developmental disabilities. There is insufficient evidence at this time to

conclude that any one specific method is the most effective method to promote weight loss. It is

highly likely, however, that some obese individuals with developmental disabilities can and will

lose weight as a result of an exercise-based intervention, but this is not yet reinforced in

evidenced based literature. What is known, however, is that doing nothing almost guarantees

negative health outcomes in this vulnerable population.

Implications for Researchers

A great need exists for more research regarding the effectiveness of activity-based

interventions for promoting weight loss in obese adults with intellectual disabilities. There is

only one longer-term study to date on this subject (Chapman, et al., 2008). Research is also

needed to determine whether education-based classes or exercise-based interventions are the

more effective method for producing sustainable results. Individualized approaches as compared

to group methods are another aspect of study that needs further research. Programs that are

exclusively exercise or diet-focused compared to those that are multifaceted is still another area

in which the research is yet to be completed.

Recommendations for Best Practice

The studies located for this evidence based practice review indicate limited effectiveness

in these interventions’ specific approaches to promoting weight loss in obese adults with

developmental disabilities. Supervised, exercised-based approaches to intervention with this


population for this purpose may be effective in promoting weight loss or preventing further

weight gain in these individuals. Given the complexity of the nature of promoting safe, effective,

client-centered, sustainable, and long-term health outcomes for this population, therapists must

continue to search the literature carefully and reflect methodically and critically when

determining the best intervention strategies to use with each and every client in their care.


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Reference Purpose of Question

Population Design Level of Evidence

Outcome Measures

Intervention Result Conclusion or Recommendation

Bazzano, A., Zeldin, A., Shihady, D., Garro, N., Allevato, N., & Lehrer, D. (2009). The healthy lifestyle change program: a pilot of a community-based health promotion intervention for adults with developmental disabilities. American Journal of Preventive Medicine, 37: S201-S208. doi:10.1016/j.amepre.2009.08.005. Retrieved November 28, 2012 from American Journal of Preventive Medicine Online

To determine the effectiveness of a 7-month twice-weekly education and exercise program to result in weight-loss, improved dietary habits, increased exercise, increased self-efficacy, improved access to health care, improved life satisfaction and increased community capacity.

Adults aged 18-65 who were overweight/obese (BMI>25) with another risk factor for diabetes or metabolic syndrome or who had a diagnosis of diabetes, and received services from a community agencyN=44

Single group pre-post test

Level III

Changes in weight, BMI, abdominal girth, access to care, and self –reported nutrition, physical activity, and life satisfaction

The Healthy Lifestyle Change Program, a 7-month, twice weekly education and exercise program.

Two-thirds of participants maintained or lost weight, with a mean loss of 2.6 pounds and a median weight loss of 7 lbs. Average BMI decreased by 0.5kg/m2. Abdominal girth decreased in 74% of participants. 61 % of participants reported increased physical activity. Mean exercise frequency and duration increased. Significant improvements in nutritional habits and self-efficacy were reported. 59% of participants showed improvements in life satisfaction.

The HCLP resulted in improved lifestyles, weight loss success, and increased community capacity. Further studies should consider using this type of community-based, peer mentor-led approach to design, implement and examine larger, randomized controlled studies of health promotion interventions, with longer-term outcomes for those with developmental disabilities.

Appendix 1: Matrix


database.Chapman, M., Craven, M., & Chadwick, D. (2005). Fighting fit? an evaluation of health practitioner input to improve healthy living and reduce obesity for adults with learning disabilities. Journal of Intellectual Disabilities, 9, 131-144. doi:10/1177/1744629505053926. Retrieved December 2, 2012 from Sage Journals Online database.

To determine the effectiveness of an individualized program of health practitioner input with obese individuals with learning disabilities that incorporated home visits, advice, design of activity programs, providing health promotion information and taking baseline and follow-up measurements.

Adults aged 19-70, who attended three resource centers and were mobile enough to stand on scales.N=88

Non-randomized comparison group (Pre-posttest)Design.

Level III

Body Mass Index (BMI)

The Fighting Fit health promotion program, an individualized program that utilized a healthy living coordinator to utilize home visits, advice giving, design of activity programs, provision of health promotion information and taking baseline and follow-up measurements

Mean BMI decreased for the input group, although it increased for the non-input group over the same period of time. The input group achieved statistically significant weight-reduction results compared to the control group

Fighting Fit resulted in decreased mean BMI and statistically significant weight loss for the intervention group over a 12-month period of time. Further studies should consider using health practitioners working directly to create individualized programming to promote weight loss. Further research is needed to determine whether weight loss is maintained over time, and gather more detailed information about the components of


successful interventions.

Chapman, M., Craven, M., & Chadwick, D. (2008). Following up fighting fit: the long-term impact of health practitioner input on obesity and BMI amongst adults with intellectual disabilities. Journal of Intellectual Disabilities, 12:309-323. doi: 10.1177/1744629508100557. Retrieved November 28, 2012 from Sage Journals Online database.

To determine the long-term effectiveness of an individualized program of health practitioner input with obese individuals with intellectual disabilities that incorporated home visits, advice, design of activity programs, providing health promotion information and taking baseline and follow-up measurements

Adults aged 19-70, who attended three resource centers and were mobile enough to stand on scales.N=73

Non-randomized comparison group (Pre-posttest)Design.

Level III

Body Mass Index (BMI)

The Fighting Fit health promotion program, an individualized program that utilized a healthy living coordinator to utilize home visits, advice giving, design of activity programs, provision of health promotion information and taking baseline and follow-up measurements

After 6 years of intervention, there were no statistically significant differences in the mean BMI between the control (no input) group and the experimental (input) group.

The mean BMI for the group receiving input from a healthy living coordinator reduced slightly over 6 years. This change was not statistically significant when compared to the mean BMI of the control group. More research is needed both to identify factors which influence weight loss in individuals with intellectual disabilities and to evaluate best way to promote weight loss.

Ewing, G., McDermott, S., Thomas-Koger, M., Whitner, W., & Pierce, K.

To determine the effectiveness of an 8 weight cardiovascular health program for

Adults who attend a Family Practice Center,

Case-controlled, non-randomized pre-

Level III

Body Mass Index (BMI), knowledge of healthy eating choices, self-

An 8-week, once a week, 90-minute cardiovascular risk reduction

Mean BMI decreased by .89 for normal learners and not at all for the group with MR. BMI decreased

A group educational program to reduce cardiovascular


(2004). Evaluation of a cardiovascular health program for participants with mental retardation and normal learners. Health, Education, and Behavior, 31: 77-87. doi: 10.1177/1090198103259162. Retrieved November 28, 2012 from Sage Journals Online database.

both normal learners and individuals with mental retardation.

including individuals with Mental RetardationN=155

post test design

report of fruit and vegetable intake, and exercise

group teaching program that emphasized exercise, nutritional choices, and stress reduction lessons. Lessons were followed by an optional brisk walk. Participants were offered 2-4 home visits to establish an individualized exercise program, develop a dietary plan, and make a grocery store visit to identify healthy choices

by at least .75 units (approximately 5 pounds) for 18.5% of adults with MR and 44.3% of normal learners. Normal learners who attended more classes reported a substantial increase in their consumption of fruits and vegetables. Home visits were associated with increases in exercise for both groups.

risk factors can be successful with some individuals with MR, though it was more successful with normal learners. Future studies are needed include others who influence diet and exercise patterns, such as residential staff. Further research is needed to determine if changes are long-lasting.

Heller, T., Hsieh, K., & Rimmer, J. (2004). Attitudinal and psychosocial outcomes of a fitness and health education program on adults with down syndrome.

To determine the effectiveness of a 12-week 3 days-per-week fitness and health education program on adults with Down Syndrome.

Adults with Down Syndrome aged 30-58

N=53

Experimental, randomized control trial.

Level II

Likert scale rating for health status, Instrumental and Activities of Daily Living Scales by appointed guardian, Likert scale rating of self-reported

12 week, 3 days per week, 2 hours/day exercise and health education program. Fitness component included 30-35 minutes of cardiovascular exercise and 15 minutes of

Compared to control group, intervention group participants perceived fewer barriers to exercise, had higher expectations of the results of their exercise, and much improved sense of self-efficacy as compared to controls.

A health promotion program consisting of exercise and health education can results in more positive attitudes toward exercise and


American Journal on Mental Retardation, 109:175-185. Retrieved November 28, 2012 from EBSCOhost database.

health and Cognitive-Emotional Barriers to Exercise Scale; Exercise Perception Scale; Non-standardized self efficacy measure. Community Integration Scale; Children’s Depression Inventory (adapted); Life Satisfaction Scale.

muscle strength and endurance training. Health education was the Exercise and Nutrition Curriculum for Adults with Developmental Disabilities

No difference between groups on measure of community integration. Minimal difference in depression. Significant difference with life satisfaction; experimental group showed increased satisfaction.

improvements in some psychosocial outcomes for middle age and older adults with Down syndrome. Further research is needed to examine the long-term adherence and benefits of this type of program, and to identify specifically which features of the program resulted in the greatest improvements in psychosocial outcomes.

Marshall, D., McConkey, R. & Moore, G., (2002). Obesity in people with intellectual disabilities: the impact of nurse-led health screenings and

To determine the effectiveness of a health promotion intervention in promoting weight loss in obesity individuals with intellectual disabilities.

Adults aged 18-65 attending a special school or day center or living in a residential facility within the


Level III

Body Mass Index (BMI) and weight

Between 6 and 8 weekly sessions for two hours per session.

Participants lost a statistically significant amount of weight and decreased BMI over 6 weeks.

A health promotion program designed for people with intellectual disabilities can be an effective method for promoting


health promotion activities. Issues and Innovations in Nursing Practice, 41:147-153. Retrieved November 28, 2012 from EBSCOhost.

area served by a Health and Social Service Trust in Northern Ireland.N=20

weight loss in obese individuals with these conditions. Further research is needed to identify the most effective methods for promoting healthier lifestyles in developmentally disabled teens and young adults, as well as to explore effective interventions for underweight adults with intellectual disabilities.

Melville, C., Boyle, S., Miller, S., Macmillan, S., Penpraze, V., Pert, C., Spanos, D….& Hankey, C. (2011). An open study for

To determine the effectiveness of the TAKE 5 multi-component weight-loss intervention, which included a diet and guidelines for a minimum of 30 minutes of

Adults, aged 23-71 with intellectual disabilities and obesity

N=47


Level III

Body weight, BMI, waist circumference, levels of physical activity and sedentary behavior of participants

TAKE 5 multi-component weight-loss intervention, which included an individualized diet to create an energy deficit of

Participants lost a statistically significant amount of weight. There were significant decreases in BMI and waist circumference. 36% lost 5% or more of their total body weight and 51 % lost

TAKE-5 is an effective weight-loss intervention for adults with intellectual disabilities and obesity. Further research is


the effectiveness of multi-component weight-loss intervention for adults with intellectual disabilities and obesity. British Journal of Nutrition, 105, 1553-1562.

accumulated moderate-intensity physical activity 5 days/week.

600 calories/day, 9, 40-60 minute sessions over 6 months. Activity guidelines and monitoring, including walking pedometer and walking targets.

between 0 and 5% of their initial body weight. 12.8% increased their weight.

needed to examine the effectiveness of multi-component weight-loss interventions in larger, randomized controlled studies.

Saunders, R., Saunders, M., Donnelly, J., Smith, B., Sullivan, D., Guilford, B, & Rondon, M. (2011). Evaluation of an approach to weight loss in adults with intellectual or developmental disabilities. Intellectual and Developmental Disabilities, 49, 103-112.

To determine the effectiveness of a 6 month weight-loss intervention, which included an individualized diet plan and monthly meetings at which a monetary reward was provided for self-recorded intake and exercise records

Adults aged 18-62 with intellectual disabilities and overweight or obeseN=73


Level III

Body Mass Index (BMI), weight, and waist circumference

Initial orientation meeting 60-90 minutes. Monthly check-in meeting with research team.1200-1300 calorie diet for 6 months with shakes and Stoplight guides for calorie counters. Weight chart. Intake tracking form. Game board to track physical activity. Step counter. Monetary awards for completion of

Over 85% of the participants lost weight in the diet phase, with an average of 6.36% of baseline weight. Participants that remained in the program for the 6 month follow-up phase averaged weight loss of 9.4% of baseline.

A weight loss program designed for obese adults with developmental disabilities can be an effective intervention for promoting weight loss in adults with these conditions. Further research is needed to examine the roles of choice and self-determination in weight loss interventions with adults


data sheets. with developmental disabilities and examine the effectiveness of weight-loss interventions in larger, randomized controlled trials.

aBased on Holm (2000).

Documents

SULLIVAN TU DOT EBP review 2012