title: Effectiveness of a walking programme to support adults with intellectual disabilities to increase physical activity: walk well cluster-randomised controlled trial.
abstract: BACKGROUND
  Programs to change health behaviours have been identified as one way to reduce health inequalities experienced by disadvantaged groups. The objective of this study was to examine the effectiveness of a behaviour change programme to increase walking and reduce sedentary behaviour of adults with intellectual disabilities.
  
  
  METHODS
  We used a cluster randomised controlled design and recruited participants over 18 years old and not regularly involved in physical activity from intellectual disabilities community-based organisations. Assessments were carried out blind to allocation. Clusters of participants were randomly allocated to the Walk Well program or a 12-week waiting list control. Walk Well consisted of three face-to-face physical activity consultations incorporating behaviour change techniques, written resources for participants and carers, and an individualised, structured walking programme. The primary outcome measured with accelerometers was change in mean step count per day between baseline and 12 weeks. Secondary outcomes included percentage time per day sedentary and in moderate-vigorous physical activity (MVPA), body mass index (BMI), and subjective well being.
  
  
  RESULTS
  One hundred two participants in 50 clusters were randomised. 82 (80.4%) participants completed the primary outcome. 66.7% of participants lived in the most deprived quintile on the Scottish Index of Multiple Deprivation. At baseline, participants walked 4780 (standard deviation 2432) steps per day, spent 65.5% (standard deviation 10.9) of time sedentary and 59% percent had a body mass in the obesity range. After the walking programme, the difference between mean counts of the Walk Well and control group was 69.5 steps per day [95% confidence interval (CI) -1054 to 1193.3]. There were no significant between group differences in percentage time sedentary 1.6% (95% CI -2.984 to 6.102), percentage time in MVPA 0.3% (95% CI -0.7 to 1.3), BMI -0.2 kg/m(2) (95% CI -0.8 to 0.4) or subjective well-being 0.3 (95% CI -0.9 to 1.5).
  
  
  CONCLUSIONS
  This is the first published trial of a walking program for adults with intellectual disabilities. Positively changing physical activity and sedentary behaviours may require more intensive programmes or upstream approaches to address the multiple social disadvantages experienced by adults with intellectual disabilities. Since participants spent the majority of their time sedentary, home-based programmes to reduce sitting time may be a viable health improvement approach.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN50494254.
authors.affiliation: University of Glasgow, Institute of Health and Wellbeing, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH, UK. craig.melville@glasgow.ac.uk.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Melville
authors.affiliation: University of Glasgow, Institute of Health and Wellbeing, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH, UK. Fiona.Mitchell@glasgow.ac.uk.
authors.forename: Fiona
authors.initials: F
authors.lastname: Mitchell
authors.affiliation: Social Work and Social Policy, Lord Hope Building, University of Strathclyde, Glasgow, G4 OLT, UK. Kirsten.Stalker@strath.ac.uk.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Stalker
authors.affiliation: MRC Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield St, Glasgow, G2 3QB, UK. Lynsay.Matthews@glasgow.ac.uk.
authors.forename: Lynsay
authors.initials: L
authors.lastname: Matthews
authors.affiliation: Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Boyd Orr Building, University Avenue Glasgow, Glasgow, G12 8QQ, UK. Alex.McConnachie@glasgow.ac.uk.
authors.forename: Alex
authors.initials: A
authors.lastname: McConnachie
authors.affiliation: Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Boyd Orr Building, University Avenue Glasgow, Glasgow, G12 8QQ, UK. Heather.Murray@glasgow.ac.uk.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Murray
authors.affiliation: Social Work Services, Glasgow City Council, 40 John Street, Glasgow, G1 1JL, UK. Chris.Melling@glasgow.gov.uk.
authors.forename: Chris
authors.initials: C
authors.lastname: Melling
authors.affiliation: University of Edinburgh, Physical Activity for Health Research Centre, St Leonard's Land, Holyrood Road, Edinburgh, EH8 8AQ, UK. Nannette.Mutrie@ed.ac.uk.
authors.forename: Nanette
authors.initials: N
authors.lastname: Mutrie
mesh_terms: D000328:Adult; D015992:Body Mass Index; D016000:Cluster Analysis; D005260:Female; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008607:Intellectual Disability / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D015397:Program Evaluation; D011788:Quality of Life; D012017:Referral and Consultation; D016138:Walking / Q000706:statistics & numerical data*