Individual and family based approaches to increase physical activity in adolescents with IDD

摘要 患有智力和发育障碍（IDD）的青少年身体活动较少， 心血管健康与正常发育的同龄人相比。患有缺碘症的青少年亦须面对 参与中度至剧烈体力活动（MVPA）的其他障碍，包括依赖 家长对运动设施的交通，缺乏适当的运动设施，缺乏PA专业人员 缺乏关于缺碘症青少年具体需要的专门知识，缺乏同伴支持。先前 增加IDD青少年MVPA的干预措施取得的成功有限，至少部分原因是 要求父母将青少年送到运动设施，这是一个重大障碍， 家庭已经在处理为有特殊需要的青少年提供日常护理的负担。我们最近 开发了一个远程系统，在一名训练有素的健康教练的领导下，向患有缺碘症的青少年群体提供MVPA 通过平板电脑上的视频会议。这种方法消除了对 交通工具，提供健康教练和其他参与者的社会互动和支持， 可行的，最小的家长参与。我们建议18个月。试验（6个月）有效，6个月。维护，6 莫斯无接触随访），以比较114名IDD青少年客观评估的MVPA变化 随机分配至仅针对青少年（AO）的单水平干预或多水平干预 向青少年和父母提供（A+P）。两个干预组的青少年将被要求 参加由经过培训的健康教练使用视频会议进行的家庭小组MVPA课程 软件，并完成每周的活动家庭作业。A+P组青少年的父母 将被要求参加小组视频MVPA会议和家庭作业活动，参加 与青少年就MVPA在健康和功能方面的作用进行教育/支持会议， 增加MVPA在他们的青少年和自己的战略，并将提供获得 Facebook页面与A+P组中其他青少年的父母互动。我们的主要目的是比较 MVPA的平均增加（最小/ d）AO组与A+P组之间0 ~ 6个月。其次，我们将 比较MVPA、久坐时间、心血管健康、肌肉力量、运动能力质量的变化， 寿命和青少年在18个月内达到美国建议的60分钟MVPA/d的百分比。 我们还将探讨过程变量/参与者特征的影响，包括小组出席率 视频（AO-青少年; A+ P-青少年/家长）和教育/支持会议（仅A+P），自我监测 MVPA（AO-青少年; A+ P-青少年/父母），父母使用Facebook页面（仅A+P），同伴 在小组PA会议期间的互动/支持，青少年自我效能感，社会支持和PA的障碍， 父母MVPA、对PA的信念和态度、父母时间限制、年龄、性别和IDD诊断。

Abstract Adolescents with intellectual and developmental disabilities (IDD) are less physically active and have lower cardiovascular fitness compared with their typically developing peers. Adolescents with IDD also face additional barriers to participation in moderate-to-vigorous physical activity (MVPA) including dependence on parents for transportation to exercise facilities, lack of appropriate exercise facilities, lack of PA professionals with expertise regarding the specific needs of adolescents with IDD, and lack peer support. Previous interventions to increase MVPA in adolescents with IDD have met with limited success, at least in part due to requiring parents to transport their adolescent to an exercise facility, which represents significant barrier to families already dealing with the burden of providing routine care for a special needs adolescent. We recently developed a remote system to deliver MVPA, led by a trained health coach, to groups of adolescents with IDD in their homes via video conferencing on a tablet computer. This approach eliminates the need for transportation, provides social interaction and support from both the health coach and other participants, and is feasible with minimal parent involvement. We propose an 18 mo. trial (6 mos. active, 6 mos. maintenance, 6 mos. no-contact follow-up) to compare changes in objectively assessed MVPA in 114 adolescents with IDD randomized to a single level intervention delivered only to the adolescent (AO) or a multi-level intervention delivered to both the adolescent and a parent (A+P). Adolescents in both intervention arms will be asked to attend home-based, group MVPA sessions conducted by a trained health coach using video conferencing software and to complete a weekly activity homework assignment. Parents of adolescents in the A+P group will be asked to participate in the group video MVPA sessions and homework activity, attend educational/support sessions with their adolescents regarding the role of MVPA in health and function and strategies for increasing MVPA in both their adolescent and themselves, and will be provided access to a Facebook page to interact with parents of other adolescents in the A+P arm. Our primary aim is to compare mean increases in MVPA (min./d) between the AO and A+P groups from 0 to 6 mos. Secondarily we will compare changes in MVPA, sedentary time, cardiovascular fitness, muscular strength, motor ability quality of life and the percentage of adolescents achieving the US recommendation of 60 min. MVPA/d across 18 mos. We will also explore the influence of process variables/participant characteristics including attendance at group video (AO-adolescent; A+P-adolescent/parent) and education/support sessions (A+P only), self-monitoring of MVPA (AO-adolescent; A+P-adolescent/parent), parental use of Facebook page (A+P only), peer interactions/support during group PA sessions, adolescent self-efficacy, social support and barriers for PA, parental MVPA, beliefs and attitudes toward PA and parental time constraints, age sex and IDD diagnosis.