Author
HUTZLER Y.; KORENSKY O.;
Motivational correlates of physical activity in persons with an intellectual disability: a systematic literature review.
Journal citation/publication details
Journal of Intellectual Disability Research, 54(9), September 2010, pp.767-786.
Summary
Twenty three studies, including seven intervention studies, were included in the review. The studies varied widely with regard to study design, in particular the range of activities offered, the age and degree of impairment of the participants and the methods of recruitment. There was some evidence that exercise- and sport-related activity promote well-being in persons with intellectual disability (ID). The lengthy discussion focuses on motivational determinants, motivational outcomes of participation, and barriers to participation in relation to theoretical frames of reference.
Context
People with an intellectual disability are at higher risk of coronary disease and obesity than the general population. They are also less likely to participate in physical activity. Moves to implement exercise programmes for persons with ID have been hampered by a lack of motivation in this population. The aim of this systematic review was to examine studies ‘focusing on motivational correlates of participation in sport, recreation or health-related physical activities in persons with ID’.
Methods
What sources were searched?
Four databases were searched up to October 2008: SPORTDiscus, Medline, PsycINFO, and the Cochrane Library. Other sources included an annotated bibliography of the Special Olympics and an issue of Adapted Physical Activity Quarterly published in January 2009.
What search terms/strategies were used?
Terms for intellectual disability or mental retardation; physical exercise and sport, and; motivation, adherence, participation and compliance were used in the searches. Search strategies were tailored to the individual databases. Specific search strategies are not included in the paper.
What criteria were used to decide on which studies to include?
Studies had to include participants diagnosed as having ID who were engaged in physical activity prior to or during the study period and present data on motivational correlates. Studies were limited to those published in English between 1980 and 2009.
Who decided on their relevance and quality?
Details of the study selection process are not included. Intervention studies were subjected to quality assessment using four different scales CEBM (Oxford Centre for Evidence Based Medicine), SORT (Strength of Recommendation Taxonomy), PEDro (Physiotherapy Evidence Database Scale), and the Cochrane Library Scale. The process was carried out by two independent assessors and disagreements were resolved by consultation with an expert in sport science. The results are presented in Table 5.
How many studies were included and where were they from?
A total of 126 references were retrieved from the searches and 23 were included in the review. Nine of the included papers were from the Adapted Physical Activity Quarterly. There is no indication of the country settings.
How were the study findings combined?
Data was extracted onto a standardised form. Studies were then grouped according to whether the study design was: cross-sectional; qualitative; experimental using prospective time-series-across conditions, or; a longitudinal intervention study. The review is narrative in nature with the results discussed under the following headings: design and outcome criteria, levels of scientific quality of evidence, and theoretical foundation.
Findings of the review
Seven of the studies were cross-sectional in design with the majority recruiting participants using the SO (Special Olympics) framework. Four studies were qualitative, four were experimental, and eight were intervention studies. The intervention studies, which also mainly used the SO framework for recruitment, provided a moderate level of evidence on average.
Positive psychosocial outcomes related to physical activity included increased self-confidence, self-esteem and self-concept. Improved physical fitness and elevated skill levels were also seen to serve as mediators for increased perceptions of self-efficacy and personal and social competence. There was no evidence on the benefits of segregated compared to integrated activity. Peer modelling, along with video and audio reinforcement appeared to be important in maintaining compliance.
Ten of the 23 studies were guided by a theoretical foundation. The most frequently cited theories were the Social Cognitive Learning Theory (SCLT) and the Transtheoretical Model of Change (TTM) for exercise-related motivation, and the Self-Determination Theory (SDT) for sport-related motivation.
Authors' conclusions
Exercise- and sport-related physical activities are related to positive psychosocial outcomes in persons with ID. ‘Well-designed and socially supported exercise programmes seem to improve the perceptions of self and social competence, but the degree of transfer to self-initiated compared with externally regulated activity has not been studied.’
Implications for policy or practice
Recommendations on designing exercise and sports environments for people with ID are presented.