Supporting active engagement of adults with intellectual disabilities in lifestyle modification interventions: a realist evidence synthesis of what works, for whom, in what context and why.
Let adults with ID co-create fun, social, choice-filled lifestyle sessions and they will keep coming.
01Research in Context
What this study did
Cruz-Montecinos et al. (2024) looked at 20 years of lifestyle programs for adults with intellectual disability.
They asked: what makes these adults stay active, eat better, or lose weight?
The team mapped four big ingredients: fun, friends, choice, and co-design.
What they found
Programs kept people coming when staff let clients pick activities and set personal goals.
Fun and social time were more powerful than prizes or rules.
When adults helped design the class, dropout almost stopped.
How this fits with other research
Anthony et al. (2020) saw most health classes run alone, not inside daily routines. Cruz-Montecinos et al. (2024) show how to weave them in.
ASutton et al. (2022) proved multi-step packages work for hygiene. C et al. add the social glue that keeps adults showing up.
Lemons et al. (2015) paired retirees with community mentors and saw joy rise. C et al. turn that mentor idea into a design rule for any lifestyle program.
Why it matters
You can lift these four levers today. Start each session by asking clients what sounds fun. Build in buddy time. Let them choose the music, the snack, or the walking route. End by asking what to tweak next week. These small moves turn a class into their program, not yours.
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02At a glance
03Original abstract
BACKGROUND: Lifestyle modification interventions for adults with intellectual disabilities have had, to date, mixed effectiveness. This study aimed to understand how lifestyle modification interventions for adults with intellectual disabilities work, for whom they work and in what circumstances. METHODS: A realist evidence synthesis was conducted that incorporated input from adults with intellectual disabilities and expert researchers. Following the development of an initial programme theory based on key literature and input from people with lived experience and academics working in this field, five major databases (MEDLINE, EMBASE, CINAHL, PsycINFO and ASSIA) and clinical trial repositories were systematically searched. Data from 79 studies were synthesised to develop context, mechanism and outcome configurations (CMOCs). RESULTS: The contexts and mechanisms identified related to the ability of adults with intellectual disabilities to actively take part in the intervention, which in turn contributes to what works, for whom and in what circumstances. The included CMOCs related to support involvement, negotiating the balance between autonomy and behaviour change, fostering social connectedness and fun, accessibility and suitability of intervention strategies and delivery and broader behavioural pathways to lifestyle change. It is also essential to work with people with lived experiences when developing and evaluating interventions. CONCLUSIONS: Future lifestyle interventions research should be participatory in nature, and accessible data collection methods should also be explored as a way of including people with severe and profound intellectual disabilities in research. More emphasis should be given to the broader benefits of lifestyle change, such as opportunities for social interaction and connectedness.
Journal of intellectual disability research : JIDR, 2024 · doi:10.1111/jir.13120