This document summarizes research on physical activity programs for promoting weight loss in obese adults with intellectual and developmental disabilities. It reviewed 8 studies that tested interventions combining nutrition education and exercise programs. The interventions showed some success in short-term weight loss but long-term effectiveness was unclear since most studies lacked follow-up data. Only 1 study directly tested for weight loss effects and found diminishing returns over 6 years. Overall, more research is still needed to identify interventions that can sustainably promote weight loss in this population.

1. Running 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

2. 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

3. Physical Activity Programs 3
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;

4. Physical Activity Programs 4
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

5. Physical Activity Programs 5
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

6. Physical Activity Programs 6
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.

7. Physical Activity Programs 7
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.

8. Physical Activity Programs 8
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

9. Physical Activity Programs 9
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

10. Physical Activity Programs 10
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

11. Physical Activity Programs 11
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

12. Physical Activity Programs 12
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

13. Physical Activity Programs 13
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.

14. Physical Activity Programs 14
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15. Physical Activity Programs 15
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17. Physical Activity Programs 17
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18. Physical Activity Programs 18
Reference Purpose of
Question
Population Design Level
of
Eviden
ce
Outcome
Measures
Intervention Result Conclusion or
Recommendati
on
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.am
epre.2009.08.00
5. 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
agency
N=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

19. Physical Activity Programs 19
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:10/1177/174
4629505053926.
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-
randomiz
ed
comparis
on 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

20. Physical Activity Programs 20
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:
10.1177/174462
9508100557.
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-
randomiz
ed
comparis
on 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-
controlle
d, non-
randomiz
ed 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

21. Physical Activity Programs 21
(2004).
Evaluation of a
cardiovascular
health program
for participants
with mental
retardation and
normal learners.
Health,
Education, and
Behavior, 31:
77-87. doi:
10.1177/109019
8103259162.
Retrieved
November 28,
2012 from Sage
Journals Online
database.
both normal
learners and
individuals with
mental retardation.
including
individuals
with Mental
Retardation
N=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
successfulwith
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
Experime
ntal,
randomiz
ed
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

22. Physical Activity Programs 22
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
Single
group
pre-post
test
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

23. Physical Activity Programs 23
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
developmentall
y 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
Single
group
pre-post
test
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

24. Physical Activity Programs 24
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 obese
N=73
Single
group
pre-post
test
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

25. Physical Activity Programs 25
a
Based on Holm (2000).
data sheets. with
developmental
disabilities and
examine the
effectiveness of
weight-loss
interventions in
larger,
randomized
controlled
trials.