Physical Activity, Sedentary Behavior, And Cardiometabolic Health Of Adults With Intellectual Disability: A Meta-analysis

Evidence evaluating the 2020 World Health Organization guidelines on the dose-response relationships between physical activity (PA), sedentary behavior (SB), and cardiometabolic health (CMH) outcomes in adults with intellectual disability (ID) was rated as “insufficient.” PURPOSE: Synthesize available data on quantified PA and SB levels of adults with ID, (1) comparing levels obtained by objective (e.g., wearable devices) and subjective (e.g., logs or surveys) assessment techniques and (2) evaluating their associations with CMH indicators. METHODS: Following PRISMA Guidelines, 11 electronic databases were searched through Sept 2023, yielding 7,911 records. Data from 82 studies were extracted in Covidence (v.2.0) and analyzed in STATA (v.18.0) to obtain daily steps and minutes of moderate-to-vigorous-intensity PA (MVPA), light-intensity PA (LPA), and stationary time (ST). Random-effects models estimated pooled results across studies, providing initial estimates of the association between PA or SB indicators and CMH indicators (body mass index [BMI], waist circumference [WC], body fat percentage [BF], systolic and diastolic blood pressure [BP]) in adults with ID. Two independent authors assessed risk of bias using a modified Downs and Black Checklist. RESULTS: The 82 studies included 11,117 adults with ID. Mean step-count was 6,814.4 steps/d (42 obs. from 28 studies, 95%CI [5,092.8-6,961.9]) and MVPA level was 24.8 min/d (37 obs. from 28 studies, 95%CI [20.1-29.4]). Pooled estimates obtained by solely objective techniques were significantly lower for steps (p < .01) and higher for LPA (p < .01) than by subjective techniques. BMI was reported in 55 studies (71 obs., M = 30.9 kg/m2, 95% CI [29.9-31.8]), WC in 14 studies, BF in 9 studies, and BP in 5 studies. Five studies (n range: 6-131) provided sufficient data to estimate correlations between MVPA and BMI (r range: -0.44 to +0.18, Mr = -0.18 ± 0.12). Four studies (n range: 9-60) contributed sufficient data to estimate correlations between steps/d and BMI (r range: -0.44 to -0.06, Mr = -0.19 ± 0.16). CONCLUSIONS: In adults with ID, daily step counts and MVPA minutes were negatively associated with BMI. Our findings were limited by the absence of reported empirical associations between PA, SB, and CMH indicators, necessitating more comprehensive investigations.