PROGRAM | Health Behavior Science & Promotion

By: Paige Laxton Chair: Freda Patterson Co-Chair: Sean Healy

ABSTRACT

Sedentary behavior (SB), defined as any waking behavior with an energy expenditure of ≤1.5 METs (i.e., sitting, lying), is independently associated with poor health outcomes. Adults with intellectual disabilities(ID) are at higher risk for non-communicable diseases than those without ID (Draheim, 2006; Krahn et al., 2006; Reichard et al., 2011). One possible reason for this disparity may be that individuals with ID are more likely to have cardiometabolic risk factors, such as low physical activity (Dairo et al., 2016) and high SB (Lynch et al., 2021). In fact, adults with ID spend more time sedentary than the general population (Lynch et al., 2021).

For adults with ID, there has been a recent shift towards smaller community living arrangements (CLAs), also known as group homes or community homes. This is marked by the 95% increase in adults with ID living in staffed homes with six or fewer roommates (Residential Information Systems Project [RISP], 2023). As more adults with ID are predicted to move into CLAs, reducing SB in these settings is imperative to creating healthy and supportive home environments to mitigate resident’s health risks. Decreasing high levels of SB are a critical modifiable risk factor that could be intervened upon. Limiting our ability to reduce SB in adults with ID who live in CLAs is a lack of understanding of the SB patterns of this group, and the multi-level determinants of their SB. To address this knowledge gap, the aims of this dissertation were to: 1) define and characterize patterns of SB in adults with ID that live in CLAs, and 2) identify the multi-level factors that contribute to prolonged SB in adults with ID that live in CLAs.

First, a systematic literature review to identify factors associated with physical activity and SB in adults with ID living in CLAs was completed. Due to the scarcity of research on SB in this population, the study concentrated on identifying factors related to physical activity. This resulted in the inclusion of ten articles for full text review. Data were extracted relating to study descriptions,  sample characteristics, and study findings. Factors related to PA in CLAs were identified at all levels of the social-ecological model. Intrapersonal factors (e.g., health and functional status, attitude to PA),  interpersonal factors (e.g., staff attitude, encouragement for PA, and co-participation in PA) and organizational factors (e.g., program offerings, staff education, and staff-client ratios) were prominent findings in the reviewed studies. The findings support a social-ecological approach for PA promotion in CLAs that target intrapersonal, interpersonal, and organizational factors. While SB and physical activity are not direct opposites, synthesizing factors related to physical activity produced valuable perspectives to inform our methods and underscored the need to study SB.

A cross-sectional observational study design was used to characterize SB patterns and multilevel determinants of SB in adults with ID living in CLAs. Thirty-eight adults from twenty-four different CLAs wore activPAL devices for one week to enable device-estimates of SB. ActivPAL data were processed, and the study outcomes of daily time spent in SB, SB bout lengths, sedentary breaks, and prolonged SB were generated. The residential sample were sedentary approximately 7.5 hours a day. A key finding was that nearly half of the sample spent their wake time in prolonged SB (i.e., at least 50% of their SB total time is spent in SB bouts 30 minutes). CLA managers and residents completed online-questionnaires to ascertain environmental-level and individual-level data, respectively. A novel finding was that multiple factors across the social-ecological model were associated with SB (prolonged SB and total SB) for residents with ID in community homes. On the individual level, lower independence levels for ADLs were associated with prolonged SB and higher total SB duration. Race and self-efficacy for physical activity were associated with prolonged SB. At the environmental level, perceived space to exercise was associated with total SB duration. On the organizational level, staff conflict (factional scale) was associated with higher odds of prolonged SB and higher total SB duration. These findings provide insight into the unique factors of CLAs that contribute to resident SB.

To the best of our knowledge, this is the first study to assess device-estimated SB and examine the multi-level factors related to SB in adults with ID living in CLAs. This research not only provides hypothesis-generating findings to elucidate SB patterns and multi-level factors associated with SB, but also lays the groundwork for developing targeted multi-level interventions to decrease prolonged SB. By pinpointing key areas for intervention, such as promoting ADL independence and fostering a supportive staff culture, this work paves the way for future initiatives aimed at reducing SB in this population. Future directions such as methodological refinement to improve generalizability of findings are discussed. This includes increasing sample size, completing a longitudinal study, and the creation of a valid home assessment tool

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