A Preliminary Evaluation of a
Social-Cognitive Theory-Based Structured Physical Activity
Program for Improving Fitness in Populations with an Intellectual
written by Krishna
Dipnarine (Graduate Student), Anthony
Delisle (Doctoral Student), & Christine
Stopka (Professor), Department of Health Education & Behavior,
University of Florida, Gainesville, Florida
with an intellectual disability (PID) consistently
have significantly higher rates of obesity and lower rates
of physical activity, cardiorespiratory fitness (CRF), and
muscular endurance than populations without an intellectual
Purpose: To evaluate
the efficacy and effectiveness of a Social Cognitive Theory-based
(SCT) structured physical activity intervention for PID to
increase time spent on health enhancing physical activities,
increase CRF, increase muscular endurance and decrease percentage
of total body fat.
young adults with an intellectual disability (ages 17-22,
38.5% female) participated in a 1-hour structured physical
fitness intervention, held twice a week, for 8 weeks. Physical
fitness assessments were conducted pre and post intervention.
Results: On average,
heart rate decreased 24.2% 1-minute post YMCA step test, bench
press reps increased 41.7%, upright seated-row reps increased
81.3%, seconds maintaining static plank form increased 58.4%,
wall pushups reps increased 61.7%, and muscle mass increased
from 34.83% to 35.41%.
of this study show that PID who received this SCT-based intervention
significantly increased time spent on health enhancing physical
activity, increased CRF and muscular endurance, and decreased
percentage of total body fat. This substantiates the need
for exercise programs for this population.
INTRODUCTION AND LITERATURE
Intellectual Disabilities (ID) account for 25% of all disabilities
in the population of those diagnosed with any form of a disability
according to the United States 2000 Census (Stern, 2003).
An ID is "a disability, originating before age 18, which
is characterized by significant limitations both in intellectual
functioning and in adaptive behavior as expressed in conceptual,
social, and practical adaptive skills" (Temple, Frey,
& Stanish, 2006, p. 2; American Association on Mental
Retardation, 2002, p. 8). An individual is considered to have
an ID if he or she has an Intellectual Quotient (IQ) less
than 70 (Hatton, 2002).
diseases, such as cardiovascular
disease (CVD), cancer,
and stroke are the leading causes of morbidity and mortality
in the United States (American Heart Association, 2008; McGinnis
& Foege, 1993). Obesity is increasing at epidemic rates
in the general population with more than 72 million adults
classified as obese (Bean, Olbrisch, & Stewart, 2008).
Alarmingly, obesity rates are even
greater in populations with an intellectual disability
(PID). More than two thirds (66%) of young adults with ID
are reported to be either obese or overweight (Yamaki, 2005).
Subsequently, PID are at an even greater risk of developing
and dying from CVD, cancer, and stroke when compared to populations
without an ID (Hill, Gridley, & Cnattingius, 2003; Day,
Straus, & Shavelle, 2005; Draheim, 2006).
Large prospective cohort
studies consistently show that physical inactivity and
low cardiorespiratory fitness (CRF) are strong and independent
predictors of obesity, fatal and nonfatal CVD, cancer, and
stroke rates in men and women (Warburton, Nicol, & Bredin,
2006; Peterson, Magid, & Ross, 2008). Adequate levels
of physical activity are needed to increase CRF, decrease
obesity, and to protect against the development of CVD, cancer,
and stroke (Pate, Pratt, & Blair, 1995; Kesaniemi et al.,
In 2002, the U.S. Department of Health and Human Services
(DHHS) released physical activity guidelines calling for an
hour of moderate to vigorous physical activity on five or
more days a week for young adults (U.S. DHHS, 2002). National
surveillance data and recent research estimates that less
than 15% of PID meet these guidelines, compared to 33% of
people without ID (Eaton et al., 2008, Pate, Long, & Heath,
1994; Pate, Freedson, & Sallis, 2002; Faison-Hodge &
The effectiveness of improving CRF through physical activity
in PID is poorly understood. Unfortunately, few prospective
studies have examined the relationship between physical activity,
CRF, obesity, and health outcomes in young adults with ID.
However, researchers hypothesize PID will increase CRF in
the same manner as the general population with adequate levels
of health enhancing physical activity.
THEORY OF SOCIAL-COGNITIVE FUNCTIONING
Theory (SCT) posits that behavior changes may occur from
setting personal goals based on the outcomes of these goals,
and the tasks and self-efficacy
expectations needed to achieve these goals (Heller, Hsieh,
& Rimmer, 2004; Bandura, 1977 & 1986). In accordance
with this theory, individuals are more inclined to change
their habits if they believe that
- they are appropriately reinforced to perform a behavior,
- they observe the desired behavior
and desired consequences that accompany the behavior,
- they possess the behavioral capability
to perform the desired behavior,
- and they possess the confidence
to successfully perform the desired behaviors (self-efficacy
expectations) (Heller et al., 2004).
Social-Cognitive Theory (SCT) is demonstrating the most promise
for effectively intervening on the social, environmental,
and institutional policy levels (Booth, Owen, Bauman, Clavisi,
& Leslie, 2000). SCT rationalizes that social factors,
such as peer influences, role modeling of behaviors, and vicarious
learning are significant mechanisms involved in physical activity
behaviors (Booth et al., 2000).
INCREASING PHYSICAL ACTIVY IN PID THROUGH ADAPTED PHYSICAL
Physical education (PE) classes in the school based setting
have been the focus of efforts to increase physical activity
levels in youths and adolescents. Over 82% of school districts
require schools to mainstream students with disabilities into
regular PE classes (Burgeson, Wechsler, Brener, Young, Spain,
2001). However, students with ID often do not participate
in health enhancing physical activity behaviors during PE
classes due to a number of barriers. These barriers include
the students' disability, lack of qualified adapted physical
educators, high student-to-teacher ratios which often preclude
effective adapted PE efforts, and the lack of resources necessary
to engage students with ID in health enhancing physical activity
behaviors in the traditional PE setting (Ayvazoglu, Ratliffe,
& Kozub, 2004).
This exemplifies the need of adapted PE for PID. Adapted
PE is "a diversified, direct instructional program of
developmental activities, games, sports, and rhythmical movements
suited to the interests, capabilities, and limitations of
students with disabilities" (Sherrill, 2004; Silliman-French,
Candler, French, & Hamilton, 2007).
The barriers mentioned above undermine the ability of PID
to meet the recommended levels of physical activity set by
DHHS, as well as the ability to meet national PE standards
for all children set by the National Association for Sport
and Physical Education (Ayvazoglu et al., 2004). School health
officials are calling for urgent action to address the issue
of physical inactivity and obesity in PID. For PID, the SCT
approach to intervention may result in the reduction of the
internal and external barriers to physical activity mentioned
earlier. Research is needed to inform the feasibility of developing
and implementing innovative interventions to promote health
enhancing physical activity, increase CRF, decrease obesity,
and to prevent the development of chronic disease in PID.
It is hypothesized that young adults with an ID who receive
an 8-week peer-guided, SCT-based structured physical fitness
intervention will significantly increase time spent on health
enhancing physical activities, increase cardiorespiratory
fitness, increase muscular
endurance, and decrease percentage of total body fat when
compared to pre-intervention measures. This research aims
to gain an understanding of SCT-based physical activity interventions
as they pertain to PID to develop and implement effective
and efficient programs.
Participants. The participants in this study
included 13 young adults with either mild or moderate ID (ages
17-22, 38.5% female) from a PE class within the Sidney
Lanier Center (SLC) in Florida, which is a self-contained
school exclusively for students with mild to profound ID.
Participation in the study was based on teacher recommendation,
physician approval, parent/guardian consent and the students'
own desire to participate. Each student, with his or her parent/guardian,
completed a medical release form as well as an informed-consent
form/assent script approved by the University of Florida (UF)
Institutional Review Board. SLC instructors, UF staff, and
UF student volunteers supervise participation in the program.
Intervention. The participants with ID were
engaged in a peer-guided 1-hour structured program which included
aerobic-based group games and sports activities, muscular
endurance exercises, and functional training twice a week
for 8 weeks. All physical activities were modified to adapt
to the unique capabilities of all participants in order to
achieve maximal participation. Each participant had between
one to five trainers and volunteers to work with during each
session. The trainers served to develop satisfying routines,
model the appropriate form and range of motion for each workout,
and motivate the participant to achieve better results each
time, since motivation and understanding the movement is a
major barrier to proper performance.
Data analysis. Pre and post testing on a
variety of physical fitness measures were taken immediately
prior to and following implementation of the fitness intervention.
These included a YMCA cardiorespiratory fitness test, six
muscular endurance assessments (using the same weights pre
and post), and four body composition measures as well as demographic
information. All testing was administered by trained research
assistants. Intra-rater reliability testing was conducted
to assess the accuracy and consistency of measures taken from
each research assistant performing the physical fitness testing.
The data was analyzed using a dependent paired samples t-test
to determine any differences between pre and post-intervention
measures. The traditional level of significance (alpha = 0.05)
was used to detect statistical significance.
samples t-test revealed that there were statistically
significant differences between pre and post measures in the
- The average heart rate 1-minute after the YMCA 3-minute
step test was 24.2% lower after the 8-week training program
(M = 113.77 ± 7.87 bpm) compared to before the program
(M = 150.15 ± 22.76 bpm), t(12)= 7.300, p <0 .001
with a relatively large effect size (r = 0.90).
- The average leg extension repetitions
doubled from M = 11.69 ± 4.17 to M = 22.38 ±
11.39, t(12)= -3.265, p= 0.007.
- Average bench press repetitions
significantly increased by 41.7%, from M = 10.69 ±
2.93 to M = 15.15 ± 5.58, with t(12) = -2.761, p
- Average upright seated-row repetitions
significantly increased by 81.3% from M = 14.85 ±
4.16 to M = 26.92 ± 14.07, with t(12)= -3.168, p
- The average time that each participant
maintained proper form in a static plank significantly increased
by 58.4% from M = 43.23 ± 29.29 seconds to M =68.49
± 45.72 seconds, with t(12)= -2.246, p = 0.044.
- The average number of wall-pushups
significantly increased by 61.7% from M = 12.78 ±
2.82 to M = 20.67 ± 9.04, with t(8)= -2.399, p =
The remaining results are not statistically significant
but they show a change on average between pre and post-intervention
- Average percent body fat decreased from M = 26.67% to
M = 26.55%.
- Average muscle mass percent increased
from 34.83% to 35.41%.
- The average leg curl repetitions
increased from M =14.92 to M =18.46.
- Average weight increased from M
= 155.94 lbs to M = 156.55 lbs.
- Average body mass index remained
similar between baseline and post measures (from pre M =
26.52 kg/m² to post M = 26.81 kg/m²).
- Waist circumference differed slightly
from pre M = 33.19 inches to post M = 34.85 inches.
- After accounting for an outlier,
the average maximum time for wall sits increased from M
= 39.92 seconds to M = 47.75 seconds.
- The average number of shooting
stars (in which the participant squatted and jumped to reach
a height as many times as possible in 30 seconds) remained
very similar, with pre M = 11.50 and post M = 11.75.
- The average number of mountain
climbers (in which participants were in an extended push-up
position and alternated flexing their legs to their mid-section
and extending back to original position to simulate climbing
and working the leg muscles) increased from M = 18.36 to
M = 22.36.
The results of this study supported the hypothesis that young
adults with an ID, who received an 8-week structured physical
fitness intervention, would significantly increase time spent
on health enhancing physical activities, increase CRF, and
increase muscular endurance when compared to pre-intervention
There was a decrease in percentage of total body fat, although
it was not statistically significant. The decrease in heart
rate 1-minute post-YMCA step test indicates that the participant’s
heart is able to recover from the stress (exercise) better
compared to pre-intervention measures. This is an indicator
of improved cardiorespiratory
fitness. The participants of this study were engaged in
endurance training through weight machines and functional
training exercises, as well as recreational sports which involved
continuous participation in activities that increased cardiovascular
The trainers also led the participants through various personalized
exercises and activities between pre and post testing according
to the participants' preferences. The participants were also
markedly more energetic, developed close social relations
with their trainers, and interacted with each other better
compared to pre-intervention observations. This social interaction
seems to have motivated the participants to engage in physical
activity, as the participants seemed to be more open to instruction
All of this together may account for the results obtained.
Limitations of this study include the small sample size (N
= 13) and there was not a control group, though there was
a comparison group of the UF student volunteers, which is
analyzed in a separate study.
The results of this study show strong support for the physical
benefits of a health enhancing, peer-guided, SCT-based health
intervention program as seen in the significant improvement
in fitness measures. This peer-guided approach reduces the
barrier of high student-to-teacher ratios, which often preclude
effective adapted physical education efforts, as well as the
lack of resources necessary to engage students with ID in
health enhancing physical activity in a traditional PE setting.
Further research is needed to investigate the psychosocial
benefits of this type of program, the benefits of using personalized
training programs between pre and post measures, and the efficacy
and efficiency of implementing this program structure in diverse
institutions and fitness centers as a precursor to future
programs of this type to benefit persons with intellectual
disabilities on a global scale.
is a graduate student at the University of Florida in
the Department of Health Education & Behavior, College
of Health & Human Performance. He recently completed
the Health Science honors program at UF, with a minor
in Rehabilitative Services. He has spent the last three
years working with students with intellectual disabilities
to improve fitness and quality of life. Through the University
of Florida's I-cubed
Program, he has also worked on investigating methods to
improve the participation, support, and integration of
students with disabilities in Science, Technology, Engineering
and Mathematics (STEM) sciences in postsecondary institutions.
|| Tony Delisle,
MS (ABD) is a doctoral candidate in Health Education and
Behavior, and has over 15 years of professional experience
working with children, youth, and young adults with disabilities.
His professional experience includes 12 years of special
education instruction, over 4 years of counseling wayward
youth and adolescents with disability, and 5 years experience
as a program manager for an innovative nonprofit agency
serving adolescents and young adults with disability.
As a doctoral student, Mr. Delisle is the research
director for a community academic partnership examining
the health effects of outreach programs on young adults
with an intellectual disability. Mr. Delisle is an active
member of a graduate student advisory council for UF's
Program, and provides perspectives from students with
a disability in shaping the institutional integration
of practices, programs, and policies that promote broadening
participation of students in the Science, Technology,
Engineering, & Mathematics (STEM) sciences.
|| Dr. Christine
Stopka is a full professor at the University
of Florida where she has been teaching since 1982. There,
she established the athletic training undergraduate and
graduate specializations, the Student Injury Care Center,
and the athletic training community out-reach program
serving the north central Florida area high schools. In
addition, she established the special physical education
& exercise therapy specializations, the Special PE
& Exercise Therapy Lab, the UF Adapted Aquatics program
serving students with disabilities from Pre-K through
adolescents, and the adapted physical activity community
out-reach program serving over 50 schools, centers, sites.
Interests include inclusive teaching methods for people
of all ages with disabilities. She has published over
300 books, articles, abstracts, software and videos,
made over 300 presentations, and has received over 80
university, state, national, and international honors
for her work in teaching, research, service, leadership,
and humanitarianism in the field. She is a certified
adapted physical educator (CAPE), a master teacher of
adapted aquatics (MTAA), a certified strength and conditioning
specialist (CSCS), and a certified and licensed athletic
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