Effectiveness of a walking programme to support adults with intellectual disabilities to increase physical activity: walk well cluster-randomised controlled trial What are the most effective behaviour change techniques to promote physical activity and/or reduce sedentary behaviour in inactive adults? A systematic review protocol Walk well: a randomised controlled trial of a walking intervention for adults with intellectual disabilities: study protocol Development of a multi-component lifestyle intervention for preventing type 2 diabetes and cardiovascular risk factors in adults with intellectual disabilities A single-blind, pilot randomised trial of a weight management intervention for adults with intellectual disabilities and obesity: study protocol Embedding sustainable physical activities into the everyday lives of adults with intellectual disabilities: a randomised controlled trial Research priorities for child and adolescent physical activity and sedentary behaviours: an international perspective using a twin-panel Delphi procedure Does training improve understanding of core concepts in cognitive behaviour therapy by people with intellectual disabilities? A randomized experiment. Bereaved adults with intellectual disabilities: a combined randomized controlled trial and qualitative study of two community-based interventions. Energy balance-related behaviours associated with overweight and obesity in preschool children: a systematic review of prospective studies. Improving health behaviours of Latina mothers of youths and adults with intellectual and developmental disabilities. Balanced: a randomised trial examining the efficacy of two self-monitoring methods for an app-based multi-behaviour intervention to improve physical activity, sitting and sleep in adults The effect of a healthy lifestyle programme on 8–9 year olds from social disadvantage Access to exercise referral schemes -- a population based analysis. Adults with late diagnosed PKU and severe challenging behaviour: a randomised placebo-controlled trial of a phenylalanine-restricted diet ‘On Your Feet to Earn Your Seat’, a habit-based intervention to reduce sedentary behaviour in older adults: study protocol for a randomized controlled trial A behaviour change intervention to reduce sedentary time in people with chronic obstructive pulmonary disease: protocol for a randomised controlled trial. A systematic review of school-based interventions targeting physical activity and sedentary behaviour among older adolescents Health promotion for the oldest of old people. The impact and process of a community-led intervention on reducing environmental inequalities related to physical activity and healthy eating - a pilot study Promoting a healthy diet and physical activity in adults with intellectual disabilities living in community residences: Design and evaluation of a cluster-randomized intervention Behavioural effects of phenylalanine‐free amino acid tablet supplementation in intellectually disabled adults with untreated phenylketonuria Examining the theory‐effectiveness hypothesis: A systematic review of systematic reviews
Background Programs to change health behaviours have been identified as one way to reduce health inequalities experienced by disadvantaged groups . The objective of this study was to examine the effectiveness of a behaviour change programme to increase walking and reduce sedentary behaviour of adults with intellectual disabilities . Methods We used a cluster r and omised controlled design and recruited participants over 18 years old and not regularly involved in physical activity from intellectual disabilities community-based organisations . Assessment s were carried out blind to allocation . Clusters of participants were r and omly allocated to the Walk Well program or a 12-week waiting list control . Walk Well consisted of three face-to-face physical activity consultations incorporating behaviour change techniques , written re sources for participants and carers , and an individualised , structured walking programme . The primary outcome measured with accelerometers was change in mean step count per day between baseline and 12 weeks . Secondary outcomes included percentage time per day sedentary and in moderate-vigorous physical activity ( MVPA ) , body mass index ( BMI ) , and subjective well being . Results One hundred two participants in 50 clusters were r and omised . 82 ( 80.4 % ) participants completed the primary outcome . 66.7 % of participants lived in the most deprived quintile on the Scottish Index of Multiple Deprivation . At baseline , participants walked 4780 ( st and ard deviation 2432 ) steps per day , spent 65.5 % ( st and ard deviation 10.9 ) of time sedentary and 59 % percent had a body mass in the obesity range . After the walking programme , the difference between mean counts of the Walk Well and control group was 69.5 steps per day [ 95 % confidence interval ( CI ) -1054 to 1193.3 ] . There were no significant between group differences in percentage time sedentary 1.6 % ( 95 % CI −2.984 to 6.102 ) , percentage time in MVPA 0.3 % ( 95 % CI −0.7 to 1.3 ) , BMI −0.2 kg/m2 ( 95 % CI −0.8 to 0.4 ) or subjective well-being 0.3 ( 95 % CI −0.9 to 1.5 ) . Conclusions This is the first published trial of a walking program for adults with intellectual disabilities . Positively changing physical activity and sedentary behaviours may require more intensive programmes or upstream approaches to address the multiple social disadvantages experienced by adults with intellectual disabilities . Since participants spent the majority of their time sedentary , home-based programmes to reduce sitting time may be a viable health improvement approach . Trial registration Current Controlled Trials IS RCT Introduction Large proportions of the population are not meeting recommended levels of physical activity and have increasingly sedentary lifestyles . Low levels of physical activity are predictive of poor health outcomes and time spent sedentary is related to a host of risk factors independently of physical activity levels . Building an evidence base of the best approaches to intervene in the lifestyles of inactive individuals is crucial in preventing long-term disease , disability and higher mortality rates . Methods and analysis Systematic search es will be conducted on all relevant data bases ( eg , PubMed , Scopus , CINAHL , PsycINFO ) . Studies will be included if they assess interventions aim ed at changing physical activity or sedentary behaviour levels in adults ( over 18 ) who are inactive and do not suffer from chronic conditions . Studies must also be r and omised controlled trials ( RCTs ) , have a primary outcome of physical activity or sedentary behaviour , and measure outcomes at least 6 months after intervention completion . Studies will be coded using the Behaviour Change Technique ( BCT ) taxonomy v1 and Template for Intervention Description and Replication ( TIDieR ) guidelines . 2 review ers will independently screen full-text articles and extract data on study characteristics , participants , BCTs , intervention features and outcome measures . Study quality will also be assessed independently by 2 review ers using the Cochrane risk of bias tool . A meta- analysis will be considered if there is sufficient homogeneity across outcomes . GRADE criteria will be used to assess quality of evidence . Dissemination This will be the first review to systematic ally appraise interventions aim ed at changing the physical activity or sedentary behaviour of inactive individuals using RCT design s with a 6-month follow-up post-intervention . This review will better inform intervention design ers targeting inactive population s and inform the design of a future complex intervention . Review registration number This protocol was registered with the International Prospect i ve Register of Systematic Review s ( PROSPERO ) on 17 October 2014 ( registration number : CRD42014014321 ) Background Walking interventions have been shown to have a positive impact on physical activity ( PA ) levels , health and wellbeing for adult and older adult population s. There has been very little work carried out to explore the effectiveness of walking interventions for adults with intellectual disabilities . This paper will provide details of the Walk Well intervention , design ed for adults with intellectual disabilities , and a r and omised controlled trial ( RCT ) to test its effectiveness . Methods / design This study will adopt a RCT design , with participants allocated to the walking intervention group or a waiting list control group . The intervention consists of three PA consultations ( baseline , six weeks and 12 weeks ) and an individualised 12 week walking programme . A range of measures will be completed by participants at baseline , post intervention ( three months from baseline ) and at follow up ( three months post intervention and six months from baseline ) . All outcome measures will be collected by a research er who will be blinded to the study groups . The primary outcome will be steps walked per day , measured using accelerometers . Secondary outcome measures will include time spent in PA per day ( across various intensity levels ) , time spent in sedentary behaviour per day , quality of life , self-efficacy and anthropometric measures to monitor weight change . Discussion Since there are currently no published RCTs of walking interventions for adults with intellectual disabilities , this RCT will examine if a walking intervention can successfully increase PA , health and wellbeing of adults with intellectual disabilities . Trial registration IS RCT N : IS RCT Background We report on the development of the ' STOP Diabetes ' education programme , a multi-component lifestyle behaviour change intervention for the prevention of type 2 diabetes and cardiovascular risk factors in adults with intellectual disabilities ( ID ) . Methods We combined qualitative stakeholder interviews with evidence review s to develop the intervention , guided by the MRC Framework and informed by intervention mapping and two existing diabetes prevention programmes . We conducted two pilot cycles drawing on additional stakeholder interviews to inform and refine the intervention . Results The STOP Diabetes education programme employed a theoretical framework , using sound learning and behavioural principles and concrete kinaesthetic methods , to provide the grounding for innovative games and activities to promote health behaviour change in adults with ID . Qualitative data also suggested that two educators and one support person delivering a programme of one carer session followed by seven 2.5-h sessions over 7 weeks was acceptable to service users , carers and educators and appeared to benefit the participants . Conclusions The STOP Diabetes education programme was successfully developed and is suitable for a definitive r and omized controlled trial Background The prevalence of obesity in adults with intellectual disabilities has consistently been reported to be higher than the general population . Despite the negative impact of obesity on health , there is little evidence of the effectiveness of weight management interventions for adults with intellectual disabilities and obesity . Preliminary results from a single-str and ed feasibility study of a multi-component weight management intervention specifically design ed for adults with intellectual disabilities and obesity ( TAKE 5 ) and that satisfied clinical recommendations reported that it was acceptable to adults with intellectual disabilities and their carers . This study aims to determine the feasibility of a full-scale clinical trial of TAKE 5 . Methods This study will follow a pilot r and omised trial design . Sixty-six obese participants ( body mass index ( BMI ) ≥30 kg/m2 ) will be r and omly allocated to the TAKE 5 multi-component weight management intervention or a health education ‘ active ’ control intervention ( Waist Winners Too ( WWToo ) ) . Both interventions will be delivered over a 12-month period . Participants ’ anthropometric measures ( body weight , BMI , waist circumference , percentage body fat ) ; indicators of activity ( levels of physical activity and sedentary behaviour ) and well-being will be measured at three time points : baseline , 6 and 12 months . The research er collecting outcome measures will be blind to study group allocation . Conclusions The data from this study will generate pilot data on the acceptability of r and omisation , attrition rates and the estimates of patient-centred outcomes of TAKE 5 , which will help inform future research and the development of a full-scale r and omised clinical trial . Trial registration IS RCT N52903778 Background Adults with intellectual disability ( ID ) are physically very inactive . This study will compare two approaches to increasing physical activity in adults with ID : a lifestyle physical activity ( light-moderate intensity ) approach and a structured exercise ( moderate-vigorous intensity ) approach . The trial will compare the short-term ( 3-month ) and long-term ( 9-month ) outcomes and sustainability of each approach with a usual-care control group . Methods / Design A three-arm r and omised controlled trial ( RCT ) will be conducted . Ninety adults with ID aged 18 - 55 will be r and omly assigned to one of three groups : 1 ) a lifestyle physical activity group ( n = 30 ) , 2 ) a structured exercise group ( n = 30 ) , or 3 ) a usual care control group ( n = 30 ) . Participants in both groups will receive a 12-week intervention delivered by exercise specialists in the community with disability service staff , after which intervention will continue for 6 months , delivered by disability service staff only . Primary outcomes are aerobic fitness , 12-hour energy expenditure , and proxy-reported everyday physical activity . Secondary outcomes include objective ly assessed physical activity and sedentary behaviour , intervention compliance , functional walking capacity , participation in domestic activities , muscle strength , body composition , psychosocial outcomes , quality of life and health care costs . Discussion The trial results will determine the effectiveness and sustainability of two approaches to increasing physical activity and exercise among adults with ID.Trial registration IS RCT N77889248 ( 18 April 2012 ) Background The quantity and quality of studies in child and adolescent physical activity and sedentary behaviour have rapidly increased , but research directions are often pursued in a reactive and uncoordinated manner . Aim To arrive at an international consensus on research priorities in the area of child and adolescent physical activity and sedentary behaviour . Methods Two independent panels , each consisting of 12 experts , undertook three rounds of a Delphi methodology . The Delphi methodology required experts to anonymously answer questions put forward by the research ers with feedback provided between each round . Results The primary outcome of the study was a ranked set of 29 research priorities that aim ed to be applicable for the next 10 years . The top three ranked priorities were : developing effective and sustainable interventions to increase children ’s physical activity long-term ; policy and /or environmental change and their influence on children ’s physical activity and sedentary behaviour ; and prospect i ve , longitudinal studies of the independent effects of physical activity and sedentary behaviour on health . Conclusions These research priorities can help to guide decisions on future research directions BACKGROUND People with intellectual disabilities ( ID ) experience similar or even higher rates of mental health problems than the general population and there is a need to develop appropriate treatments . Cognitive behaviour therapy ( CBT ) is effective for a wide range of disorders in the general population . However , there is some evidence that people with ID may lack the cognitive skills needed to take part in CBT . AIMS To test if people with ID can learn skills required for CBT , specifically the ability to distinguish between thoughts , feelings , and behaviours and to link thoughts and feelings ( cognitive mediation ) . METHOD A r and omized independent groups design was used to examine the effect of training in CBT on two tasks measuring  CBT skills .  Thirty-four adults with ID were r and omly allocated to the experimental condition ( N=18 ) or to the control condition ( N=16 ) .  CBT skills were assessed blind at baseline and after the intervention . RESULTS The training led to significant improvements in participants ' ability to link thoughts and feelings , and this skill was generalized to new material . There was no effect of training on participants ' ability to distinguish amongst thoughts , feelings , and behaviours .  People with ID can , therefore , learn some skills required for CBT . This implies that preparatory training for CBT might be useful for people with ID . The results might be applicable to other groups who find aspects of CBT difficult BACKGROUND Bereaved adults with intellectual disabilities are known to experience prolonged and atypical grief which is often unrecognized . The aim of this project was to find an effective way to improve mental health and behavioural outcomes . METHODS Subjects were r and omized to two different therapeutic interventions : traditional counselling by volunteer bereavement counsellors , and an integrated intervention delivered by carers which offered bereavement specific support . Qualitative and quantitative methods were used to determine their effectiveness and efficacy . RESULTS The counselling intervention result ed in measurable gains both clinical ly and in terms of quality of life ; the second intervention proved impracticable in most setting s and no improvement in mental health or behaviour result ed . CONCLUSIONS Despite small numbers , the quantitative findings were highly significant , were supported by the qualitative data , and were of practical relevance to primary care practitioners and specialist mental health and intellectual disability staff The current review aim ed to systematic ally identify dietary , physical activity and sedentary behaviours in preschool children ( 4 - 6 years of age ) that are prospect ively related to overweight or obesity later in childhood . Prospect i ve studies published between January 1990 and June 2010 were selected from search es in PubMed , EMBASE , PsycINFO , CINAHL and Cochrane Library . Studies examining the prospect i ve association between at least one relevant behaviour measured during preschool period ( children aged 4 - 6 years at baseline ) in relation to at least one anthropometric measurement at follow-up ( age < 18 years ) were included . Harvest plots were used to summarize the results and draw conclusions from the evidence . Of the 8,718 retrieved papers , 23 papers reporting on 15 different study sample s were included in this review . Strong evidence was found for an inverse association between total physical activity and overweight . Moderate evidence was observed for a positive association between television viewing and overweight . Because of the heterogeneity in the assessed dietary behaviours , insufficient evidence was found for an association between  dietary intake or specific dietary behaviours and overweight . These results suggest that interventions aim ing to prevent overweight among preschool children should focus on promotion of total physical activity and limitation of screen time and that further research is needed to establish whether and which dietary behaviours are important for obesity prevention in this age group . However , despite the lack of evidence for dietary behaviours from the present review , future interventions may already target specific dietary behaviours that are highly prevalent and for which there a clear rationale as well as preliminary evidence that these behaviours are associated with overweight BACKGROUND Latina mothers who care for children with intellectual and developmental disabilities ( IDD ) over the lifespan struggle to take care of their own health needs in the context of their caregiving experience . Services are typically aim ed at the persons with IDD and not their family caregivers . Yet , attending to family caregiver needs may contribute to better long-term care of persons with IDD who remain at home . To address this unmet need , we developed a culturally sensitive health education intervention for Latina mothers who care for youth and adults with IDD . The aim of the intervention is to improve maternal health-related self-efficacy and health behaviours , and to reduce stress . METHOD A r and omised control design was employed to determine preliminary efficacy of the intervention . Paired sample t-tests were conducted to examine within-group changes from baseline to 3-month post-test . Repeated- measures analysis of covariance was used to examine the group-by-time interaction effects . RESULTS Intervention participants showed greater increases between pre- and post-test in health-related self-efficacy ; self-care , nutrition and overall health behaviours . Both groups reported decreases in depressive symptoms and caregiver burden . CONCLUSIONS While additional research is needed to determine long-term effects and to replicate findings , our results suggest that this culturally sensitive health intervention is a promising way to increase health behaviours which may lead to overall good health for Latina mothers who care for children with IDD across the lifespan Background Many adults are insufficiently physically active , have prolonged sedentary behaviour and report poor sleep . These behaviours can be improved by interventions that include education , goal setting , self-monitoring , and feedback strategies . Few interventions have explicitly targeted these behaviours simultaneously or examined the relative efficacy of different self-monitoring methods . Methods / Design This study aims to compare the efficacy of two self-monitoring methods in an app-based multi-behaviour intervention to improve objective ly measured physical activity , sedentary , and sleep behaviours , in a 9 week 2–arm r and omised trial . Participants will be adults ( n = 64 ) who report being physically inactive , sitting > 8 h/day and frequent insufficient sleep ( ≥14 days out of last 30 ) . The “ Balanced ” intervention is delivered via a smartphone ‘ app ’ , and includes education material s ( guidelines , strategies to promote change in behaviour ) , goal setting , self-monitoring and feedback support . Participants will be r and omly allocated to either a device-entered or user-entered self-monitoring method . The device-entered group will be provided with a activity tracker to self-monitor behaviours . The user-entered group will recall and manually record behaviours . Assessment s will be conducted at 0 , 3 , 6 , and 9 weeks . Physical activity , sedentary behaviour and sleep-wake behaviours will be measured using the wrist worn Geneactiv accelerometer . Linear mixed models will be used to examine differences between groups and over time using an alpha of 0.01 . Discussion This study will evaluate an app-based multi-behavioural intervention to improve physical activity , sedentary behaviour and sleep ; and the relative efficacy of two different approaches to self-monitoring these behaviours . Outcomes will provide information to inform future interventions and self-monitoring targeting these behaviours . Trial registration ACTRN12615000182594 ( Australian New Zeal and Clinical Trials Registry . Registry URL : www.anzctr.org.au ; registered prospect ively on 25 February 2015 ) Aims This study assessed the efficacy of a school-based healthy lifestyle intervention ( Sport for LIFE ) for increasing physical activity , decreasing sedentary behaviour , reducing screen time behaviour , encouraging healthy attitudes and behaviour to nutrition , and reducing body mass index ( BMI ) in 8–9-year-old primary school children from lower socioeconomic background s in Northern Irel and . Methods A non-r and omised controlled trial of 416 children from 24 schools took part . Schools were r and omly assigned to one of two groups , an intervention or control group with 12 schools in each group . The intervention group received a 12-week school-based programme based on social cognitive theory . At baseline and follow-up , groups completed question naires assessing physical activity , screen time behaviour and dietary patterns . On each occasion anthropometric assessment  s of height and weight were taken . Physical activity and sedentary behaviour were measured by accelerometry . Results Significant effects were observed for vigorous , moderate and light activity for the intervention group at follow-up . Sedentary behaviour was significantly reduced for the intervention group but not for the control group . No significant effects of the intervention on BMI , screen time behaviour or attitudes to nutrition , with the exception of non-core foods , were shown . Conclusions The programme was effective in increasing physical activity and reducing sedentary behaviour , however no significant changes in screen time behaviour and attitude to nutrition , with the exception of non-core foods , were observed . Future research ideas are offered for tackling low levels of physical activity in children BACKGROUND Sedentary behaviour is a public health priority in many countries . Hundreds of community-based exercise referral schemes have been established in Europe and USA , to increase physical activity . Experimental evidence questions the effectiveness of these schemes . No previous evaluations have considered a population approach nor provide detailed information on the types of people accessing these schemes . This is of concern given increasing health inequalities in other areas of care . Our register-based study quantified the numbers and characteristics of patients referred and accessing a district-wide exercise referral scheme .  The analysis considers the effectiveness of these schemes to a geographically defined population . METHODS Data were collected prospect ively from a patient register for referrals made to a district-wide exercise referral scheme in north-west Engl and . Analysis examined referral rates and the influence of practitioner and patient characteristics on access to the scheme . RESULTS Over 5 years , 6,610 adults were referred from 125 general practice s , with 60.8 per cent female and a mean age of 51.3 years ( SD 12.6 ) . This represents 4 per cent of the adult sedentary population in that district . The most common reason for referral was musculoskeletal or cardiovascular risk . Overall , 79 per cent attended at least the first appointment , with statistically significant predictors by age and reason for referral . Those referred for ' fitness ' or ' mental health ' were most likely to attend . Patients in the youngest and oldest age groups were least likely to attend . Patient 's sex and deprivation and the number of patients referred by each general practice did not influence attendance . CONCLUSIONS Primary -care patients seem to view the concept of exercise referral schemes positively but practitioners remain reluctant to refer many of their sedentary patients . There is doubt that exercise referral schemes like this will influence population levels of sedentary behaviour , when considered alongside their impact on physical activity in the longer term Background : Although early diagnosis and treatment in phenylketonuria ( PKU ) leads to excellent outcomes , a population of adults born before the introduction of newborn screening exists . They can have severe intellectual disabilities and behavioural problems , and are often dependent on full-time carers . Anecdotal evidence suggests that a diet that lowers blood phenylalanine concentration can have significant benefits upon behaviour . Methods : A prospect i ve double-blind r and omised placebo-controlled crossover trial of phenylalanine-restricted diet was performed in a group of 34 adults ( aged 21–61 years , median 49 ) with late diagnosed PKU with severe challenging behaviour . Results : Only 17 completed the 60 week study : seven withdrew before the end of the baseline period ; five withdrew during the first diet period ; five withdrew during the second diet period ( after moving into placebo phase ) . The mean ( SD ) blood phenylalanine was 1570 ( 222 ) μmol/l during baseline , 553(158 ) μmol/l during the active phase and 1444 ( 255 ) μmol/l during the placebo phase . In the 22 participants exposed to both active and placebo phases , no differences were demonstrated in behaviour assessed by the Aberrant Behavior Checklist and Vinel and Adaptive Behavior Scales , behaviour diaries or on video analysis of direct observations . However , 76 % of carers ’ comments were scored as positive during the active phase , compared with 54 % during the placebo phase ( χ2 = 38.06 , p<0.001 ) . Conclusions : There are significant challenges in study ing people with intellectual disabilities and considerable difficulties in instituting phenylalanine-restricted diet in this population . However , if attempted , there are potential benefits to quality of life for the individuals with PKU and their carers Background Many older adults are both highly sedentary ( that is , spend considerable amounts of time sitting ) and physically inactive ( that is , do little physical activity ) . This protocol describes an exploratory trial of a theory-based behaviour change intervention in the form of a booklet outlining simple activities ( ‘ tips ’ ) design ed both to reduce sedentary behaviour and to increase physical activity in older adults . The intervention is based on the ‘ habit formation ’ model , which proposes that consistent repetition leads to behaviour becoming automatic , sustaining activity gains over time . Methods The intervention is being developed iteratively , in line with Medical Research Council complex intervention guidelines . Selection of activity tips was informed by semi-structured interviews and focus groups with older adults , and input from a multidisciplinary expert panel . An ongoing preliminary field test of acceptability among 25 older adults will inform further refinement . An exploratory r and omized controlled trial will be conducted within a primary care setting , comparing the tips booklet with a control fact sheet . Retired , inactive and sedentary adults ( n = 120 ) aged 60 to 74 years , with no physical impairments precluding light physical activity , will be recruited from general practice s in north London , UK . The primary outcomes are recruitment and attrition rates . Secondary outcomes are changes in behaviour , habit , health and wellbeing over 12 weeks . Discussion Data will be used to inform study procedures for a future , larger-scale definitive r and omized controlled trial . Trial registration Current Controlled Trials IS RCT N47901994 INTRODUCTION Replacing sedentary behaviour with light intensity physical activity ( ie , activities classified as less than three metabolic equivalents , such as slow-paced walking ) may be a more realistic strategy for reducing cardiometabolic risk in people with chronic obstructive pulmonary disease than only aim ing to increase levels of moderate-vigorous intensity physical activity . Behaviour change interventions to reduce sedentary behaviour in people with chronic obstructive pulmonary disease have not yet been developed or tested . RESEARCH QUESTIONS Is a 6-week behaviour change intervention effective and feasible in reducing sedentary time in people with chronic obstructive pulmonary disease ? DESIGN This study will be a multi-centre , r and omised , controlled trial with concealed allocation , assessor blinding , and intention-to-treat analysis , comparing a 6-week behaviour change intervention aim ed at reducing sedentary time with a sham intervention in people with chronic obstructive pulmonary disease . PARTICIPANTS AND SETTING Seventy participants will be recruited from the waiting lists for pulmonary rehabilitation programs at Royal Prince Alfred Hospital and Prince of Wales Hospital , Sydney , Australia . INTERVENTION The behaviour change intervention aims to reduce sedentary time through a process of guided goal setting with participants to achieve two target behaviours : ( 1 ) replace sitting and lying down with light-intensity physical activity where possible , and ( 2 ) st and up and move for 2minutes after 30minutes of continuous sedentary time . Three face-to-face sessions and three phone sessions will be held with a physiotherapist over the 6-week intervention period . The ' capability ' , ' opportunity ' , ' motivation ' and ' behaviour ' ( COM-B ) model will be applied to each participant to determine which components of behaviour ( capability , opportunity or motivation ) need to change in order to reduce sedentary time . Based on this ' behavioural diagnosis ' , the Behaviour Change Wheel will be used to systematic ally select appropriate behaviour change techniques to assist participants in achieving their weekly goals . Behaviour change techniques will include providing information about the health consequences of sedentary behaviour , self-monitoring and review of weekly goals , problem-solving of barriers to achieving weekly goals , and providing feedback on sedentary time using the Jawbone UP3 activity monitor . CONTROL The sham intervention will consist of weekly phone calls for 6 weeks , to enquire whether the participants ' health status has changed over the intervention period ( eg , hospitalised for an acute exacerbation ) . No instructions regarding physical activity or exercise will be given . MEASUREMENTS Outcomes will be assessed at baseline , at the end of the 6-week intervention period , and at the 3-month follow-up . Primary outcome measures will be : ( 1 ) total sedentary time , including the pattern of accumulation of sedentary time , assessed by the activPAL3 activity monitor , and ( 2 ) feasibility of the intervention assessed by uptake and retention of participants , participant compliance , self-reported achievement of weekly goals , and adverse events . Secondary outcome measures will include functional exercise capacity , health-related quality of life , domain-specific and behaviour-specific sedentary time , patient activation , and anxiety and depression .  Semi-structured interviews will be conducted with participants who receive the behaviour change intervention to explore acceptability and satisfaction with the different components of the intervention . ANALYSIS Analysis of covariance ( ANCOVA ) will be used to calculate between-group comparisons of total sedentary time and the number of bouts of sedentary time>30minutes after adjusting baseline values . Uncertainty about the size of the mean between-group differences will be quantified with 95 % CI . Within-group comparisons will be examined using paired t-tests and described as mean differences with 95 % CIs . Secondary outcome measures will be analysed similarly . The feasibility measures will be analysed descriptively . Semi-structured interviews will be conducted until data saturation is achieved and there are no new emerging themes . De-identified interview transcripts will be coded independently by two research ers and analysed alongside data collection using the COM-B model as a thematic framework . DISCUSSION / SIGNIFICANCE If behaviour change interventions are found to be an effective and feasible method for reducing sedentary time , such interventions may be used to reduce cardiometabolic risk in people with chronic obstructive pulmonary disease . An approach that emphasises participation in light-intensity physical activity may increase the confidence and willingness of people with chronic obstructive pulmonary disease to engage in more intense physical activity , and may serve as an intermediate goal to increase uptake of pulmonary rehabilitation ABSTRACT Lack of  physical activity  (  PA  ) and high levels of sedentary behaviour ( SB ) have been associated with health problems . This systematic review evaluates the effectiveness of school-based interventions to increase PA  and decrease SB  among 15–19-year-old adolescents , and examines whether intervention characteristics ( intervention length , delivery mode and intervention provider ) and intervention content ( i.e. behaviour change techniques , BCTs ) are related to intervention effectiveness . A systematic search of r and omised or cluster r and omised controlled trials with outcome measures of PA and /or SB rendered 10 results . Risk of bias was assessed using the Cochrane risk of bias tool . Intervention content was coded using Behaviour Change Technique Taxonomy v1 . Seven out of 10 studies reported significant increases in PA . Effects were generally small and short-term ( Cohen 's d ranged from 0.132 to 0.659 ) . Two out of four studies that measured SB reported significant reductions in SB . Interventions that increased PA  included a higher number of BCTs , specific BCTs ( e.g. , goal setting , action planning and self-monitoring ) , and were delivered by research staff . Intervention length and mode of delivery were unrelated to effectiveness . More studies are needed that evaluate long-term intervention effectiveness and target SBs among older adolescents AIM The aim of this study was to explore the factors that contribute to health promotion in the oldest old and the barriers that prevent it . METHOD A non-r and om sample ( n = 52 ) of people aged 80 and older participated in a descriptive correlational study . Respondents completed a series of two Likert-type question naires . The  Health Promoting Lifestyle Profile II  ( Walker et al 1995 ) and  Barriers to Health Promoting Activities  for Disabled Persons Scale ( Becker et al 1991 ) were used to measure health behaviours . RESULTS Differences were noted between the age groups ( 80 - 90 and 91 - 101 ) for health responsibility , physical activity and nutrition . Impairment was the major barrier to health promotion . CONCLUSION To foster optimal living , the health , illness , function and motivation as well as age of older adults must be considered . They should be encouraged to pursue physical , social and intellectual activity , which can enable them to have active and fulfilling lives Background There is growing recognition that a sedentary lifestyle is being driven , at least in part , by environmental factors that affect individuals ' physical activity choices and health behaviours . In other words , the environments in which we live , and with which we interact , have become ones that encourage lifestyle choices that decrease physical activity and encourage over-consumption of foods . However , evidence from community-led interventions to change local neighbourhood environments to support physical activity and healthy eating is lacking . This article summarises the research protocol developed to evaluate a community-led intervention " My Health Matters " aim ed at reducing health inequalities relating to increasing physical activity and healthy eating as defined by community members themselves . Methods / Design This study includes three of the most deprived electoral wards in Stoke-on-Trent . In each of these areas , environmental factors including proximity of physical activity spaces , greenspace and leisure facilities , neighbourhood connectivity and walkability , l and -use-mix and population density , traffic , safety and crime , and food outlets will be mapped using Geographical Information Systems ( GIS ) . A community postal survey of r and omly selected addresses assessing environmental characteristics relating to physical activity , perceived health status , social capital , fruit and vegetable consumption and levels of physical activity will be undertaken ( baseline and at 2 year follow-up ) . Based on baseline findings an intervention will be design ed and implemented over a 2 year period that includes the following ; use of community participatory research to build effective community partnerships ; use of partnership consensus to identify , prioritise and design intervention(s ) related to specific health disparities ; recruitment of local residents to help with the delivery and sustainability of target intervention(s ) ; and the development of local systems for ongoing monitoring and evaluation of the intervention(s ) . Discussion A community-led and multidisciplinary approach to modifying environmental factors that support and reinforce healthful behaviours may be more successful than focusing on individual behaviour change as this approach does not exclusively rely upon individual will and capacity . Study findings will be collated in 2012 and , if successful in improving levels of physical activity and healthy eating , will help to inform the design of a larger area-based , cluster r and omized controlled trial to determine effectiveness Background Many adults with intellectual disabilities have poor dietary habits , low physical activity and weight disturbances . This study protocol describes the design and evaluation of a health intervention aim ing to improve diet and physical activity in this target group . In Sweden , adults with intellectual disabilities often live in community residences where the staff has insufficient education regarding the special health needs of residents . No published lifestyle interventions have simultaneously targeted both residents and staff . Methods / Design The intervention is design ed to suit the ordinary work routines of community residences . It is based on social cognitive theory and takes 12 - 15 months to complete . The intervention includes three components : 1 ) Ten health education sessions for residents in their homes ; 2 ) the appointment of a health ambassador among the staff in each residence and formation of a network ; and 3 ) a study circle for staff in each residence . The intervention is implemented by consultation with managers , training of health educators , and coaching of health ambassadors . Fidelity is assessed based on the participation of residents and staff in the intervention activities . The study design is a cluster-r and omised trial with physical activity as primary outcome objective ly assessed by pedometry . Secondary outcomes are dietary quality assessed by digital photography , measured weight , height and waist circumference , and quality of life assessed by a quality of life scale . Intermediate outcomes are changes in work routines in the residences assessed by a question naire to managers . Adults with mild to moderate intellectual disabilities living in community residences in Stockholm County are eligible for inclusion .  Multilevel analysis is used to evaluate effects on primary and secondary outcomes . The impact of the intervention on work routines in community residences is analysed by ordinal regression analysis . Barriers and facilitators of implementation are identified in an explorative qualitative study through observations and semi-structured interviews . Discussion Despite several challenges it is our hope that the results from this intervention will lead to new and improved health promotion programs to the benefit of the target group . Trial registration numberIS RCT Aim : To evaluate the effects of phenylalanine (Phe)‐free essential amino acid ( AA ) tablets enriched in tyrosine and tryptophan on the performance of intellectually disabled adult patients with untreated phenylketonuria ( PKU ) . Methods : Phe‐free AA tablets and placebo tablets were administered to 19 untreated PKU subjects on a normal diet for 6 mo in a prospect i ve double‐blinded crossover study . The adaptive behaviour of the patients was tested prior to the study and at 6 and 12 mo after the start , using a simplified version of the Vinel and Adaptive Behaviour Scale . For each sub‐domain , the patients were rated either “ 0 ” ( for poor performance ) or “ 1 ” ( for good performance ) . Neurological signs and symptoms and specific behavioural characteristics were recorded monthly by caretakers . Every 6 mo , neurological examination of the patients was performed , and the caretakers were interviewed . The statistical significance of the results was tested by means of the Fisher 's exact and Wilcoxon tests . Results : The most significant changes were an improved concentration and the development of a meaningful smile , which were observed in 44 % and 43 % of the patients on AA tablet treatment , respectively , but not patients on placebo . Other important but less significant changes included increased awareness of external stimuli ( 63 % ) and less self‐injury ( 43 % ) , and 40 % were smiling and laughing occasionally . The mean overall rating increased from an initial value of 6.3 to 10.1 in patients when on AA tablet treatment ( p=0.002 ) , and to 7.0 in patients when on placebo ( p=0.068 ) . The difference between active AA treatment and placebo was statistically significant ( p=0.027 ) PURPOSE Health interventions based on theory may be more effective than those that are not . This review of review s synthesizes all published r and omized controlled trial ( RCT ) meta-analytic evidence from the last decade to examine whether theory-based interventions were found to be associated with more effective  adult health behaviour change interventions . METHODS Systematic review s including meta-analyses were identified by search ing Medline , CINAHL , PsycINFO , and CDSR . A narrative synthesis was used to summarize and analyse the evidence . Only review s including RCTs of health behaviour change interventions with adults aged 18 + published from 2007 to 2017 were included . RESULTS Of 8,659 articles , nine systematic review s met inclusion criteria . The majority of review s ( n = 8) suggested no increased effectiveness for theory-based compared to non-theory-based interventions for effectiveness of outcomes relating to health behaviour . Less than half of the RCTs included in the review s reported the use of theory ( 85/183 ) . Two review s suggested interventions based on control theory , motivational interviewing , or self-determination theory were associated with greater effectiveness for physical activity and /or dietary interventions and outcomes . Method ological and reporting issues limit the conclusions . CONCLUSIONS Theory-based interventions as currently operationalized in systematic review s were not found to be more effective than non-theory-based interventions . Method ological and reporting issues at study and review level may not reflect the true utility of theory use within health behaviour interventions . The promotion of theory use may benefit from using a multifaceted argument , rather than a narrow focus of increased effectiveness . Statement of contribution What is already known on this subject ? Theory use is regularly promoted by cl aim ing that it will lead to more effective behaviour change interventions . Theory use has been frequently linked to effectiveness within systematic review s of behaviour change interventions . The theory-effectiveness hypothesis has not been systematic ally examined at the systematic review level . What does this study add ? Theory use as operationalized by systematic review authors was not associated with increased effectiveness within systematic review s examining r and omized controlled trials of behaviour change interventions in adults . Interventions based on control theory , motivational interviewing , or self-determination theory were associated with greater effectiveness for physical activity and /or dietary interventions and outcomes . Theory use should be promoted using a multifaceted argument , and assertions for increased effectiveness of theory-based interventions should only be used in domains where specific evidence exists to support this cl aim
None of the studies reported the reliability and validity of the methods used to measure sedentary behaviour .
Supporting positive change in lifestyle behaviours is a priority in tackling the health inequalities experienced by adults with intellectual disabilities .
In this systematic review , we examine the evidence on the definition , measurement and epidemiology of sedentary behaviour of adults with intellectual disabilities .
Many research ers do not distinguish between insufficient physical activity and sedentary behaviour .