Physical activity of people with intellectual disability measured by motion sensor

doi:10.3969/j.issn.2095-4344.0612

Abstract

Abstract:

BACKGROUND: Documented benefits of physical activity include improvement in physical function and life skills for people with intellectual disabilities, thus reducing family burden. The measurement toll of physical activity in foreign countries has been well studied, while it is still in the early stage in China.
OBJECTIVE: To systematically analyze the researches concerning measuring physical activity using motion sensor tools in people with intellectual disabilities, so as to provide reference for physical activity health promotion program in these populations.
METHODS: Web of Science was searched with keywords of “intellectual disability, mental retardation, physical activity, exercise” from 2007 to 2017. The measurement tools must be accelerometer or pedometer.
RESULTS AND CONCLUSIONS: Accelerometer and pedometer have high validity and reliability in measurement of physical activity among people with intellectual disabilities. 0%-43% people with intellectual disabilities meet the physical activity recommendation guidelines, which is lower than the proportion of typically developing people. Cross-sectional studies show that physical activity is related to body mass index, blood pressure and VO2max. Physical activity participation is a direct factor influencing physical function, while social and environment factors are the indirect factors. Intervention of exercise and health knowledge learning can increase physical activity to some extent. Future studies should be focused on horizontal and longitudinal relationship between physical activity and health factors. The formulation and implementation of the physical activity intervention program should not only pay attention to the pertinence of the scheme design, but also pay attention to the persistence of the intervention time, while the periodicity of the effect evaluation should never be ignored.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words: Intelligence, Mental Retardation, X-Linked, Sports Medicine, Tissue Engineering

CLC Number:

R318

Wang Dandan, Zhang Lei, Wu Xueping . Physical activity of people with intellectual disability measured by motion sensor[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(36): 5889-5896.

Figures/Tables 2

身体活动研究的泰斗Biddle教授认为身体研究的主题主要包括5个方面：①身体活动的精确测量；②身体活动与健康的关系；③身体活动行为的相关因素；④评估设计的身体活动的干预方案；⑤将研究结果应用于实践操作[16]。依据Biddle教授的身体活动研究主题分类，同时根据智力障碍者身体活动研究现状，该研究主要从5个方面梳理智力障碍者身体活动研究进展：①运动传感器测量智力障碍者身体活动的有效性；②智力障碍者身体活动水平；③智力障碍者身体活动水平与健康的关系；④智力障碍者身体活动参与的影响因素；⑤智力障碍者身体活动水平的干预及效果。 2.1 运动传感器测量智力障碍者身体活动的有效性有效性也称之为效度，是指选择的测量工具或手段测量出的结果能够反映所要测量内容的精确程度以及能够测量所要测量事物的准确程度[17]。该文运动传感器测量智力障碍者身体活动的有效性主要是验证加速度计和计步器的精确性和准确性。 2.1.1 加速度计和计步器测量智力障碍者身体活动的精确性为了验证加速度计和计步器测量智力障碍者身体活动的精确性，Johnson等[18]使用身体活动问卷(Third National Health and Nutrition Examination Survey)、加速度计(Actiwatch)和计步器(Omron HJ-112)同时测量37名19-74岁智力障碍者，结果发现智力障碍者自我报告的身体活动水平与加速度计和计步器测量结果的会聚效度中低一致(r=0.34，P < 0.05)；而加速计和计步器之间的会聚效度高度一致(r=0.85，P < 0.01)。Dairo等[19]使用国际身体活动问卷(International Physical Activity Questionnaire-short version)和 Axivity AX3、GENEActiv加速度计，对不同障碍程度的20名22-70岁的智力障碍者的测量数据进行分析，发现问卷会高估每周总的身体活动时间，低估中高强度的身体活动时间。Finlayson等[20]对62名16岁以上的轻中度智力障碍的身体活动情况进行半结构式访谈，同时使用加速度计(activPAL)对其身体活动水平进行监控，结果发现自我报告与加速度计测量的总体身体活动水平一致性较差(Kappa=0.147，P=0.13)，仅有41%的人能比较精确的报告他们总的身体活动水平。由此可见，问卷在评估智力障碍者的身体活动水平时会存在不同程度的偏差，加速度计和计步器测量一致性更高，是更可靠的评估智力障碍者身体活动水平的工具。 2.1.2 加速度计和计步器测量智力障碍者身体活动的准确性唐氏综合征(DS)是由于基因问题引起的智力障碍[21]。与健全人和单纯智力障碍者相比，唐氏综合征患者的平衡能力更差[22]、动作发展水平更低，有其独特的步态特征，可能会影响运动传感器测量其身体活动水平的准确性[23]。Agiovlasitis等[24-25]为了验证加速度计输出的活动计数能否作为唐氏综合征和单纯智力障碍者代谢率和能量消耗的预测指标，使用Actigraph 7164测量唐氏综合征和单纯智力障碍者的活动计数、使用便携式心肺功能测量仪(K4b2)测量代谢当量(METs)，结果表明两个群组的活动计数(Actigraph7164)均能预测代谢率(R2=0.60和0.56，P < 0.001)，也可以作为能量消耗的预测指标(R2=0.61和0.37，P < 0.005)。为了验证计步器测量唐氏综合征步行数的精确性，Pitchford等[26-27]以直接观察法为校标，同时使用Omron HJ-112(OM)和Yamax Digiwalker SW-200(YM)2种计步器测量唐氏综合征和健全人的步行数，结果发现2种计步器的测量误差确实与人群有关：与健全人相比，计步器测量唐氏综合征患者快走、自定步速和慢走的绝对误差都更大；唐氏综合征自定步速步行时，计步器的测量结果高于实际水平，与YM相比，OM的绝对效度和相对效度都更高 (Φ=0.79，G=0.98)，即虽然计步器测量唐氏综合征的步行数时，OM的计步功能会产生系统误差和随机误差，但测量结果仍然有效，仍可作为有效的测量工具。综上可见，加速度计输出的活动计数可以作为智力障碍者能量消耗和代谢率的预测指标，计步器也可以作为唐氏综合征患者步行数的有效测量工具。但唐氏综合征患者的步态稳定性低、有氧运动能力弱的特点还是影响了计步器的精确性，然而他们步行的独特性并未影响其行走过程中的代谢率，也没有改变加速计的输出活动计数与代谢率之间的关系，因此未影响加速度计测量能量消耗的准确性。 2.2 智力障碍者的身体活动水平世界卫生组织推荐5-17岁青少年儿童每天至少进行60 min的中高强度身体活动(MVPA)，18-64岁的成年人每周至少进行 150 min中等强度身体活动(MPA)，而65岁以上成人每周至少150 min的中等强度身体活动或75 min高强度身体活动(VPA)，每次持续活动时间不少于10 min。步行10 000步也是公认的推荐量，但也有研究发现 11 500-14 000步相当于儿童青少年60 min中高强度身体活动水平，老年人和特殊人群每天7 000-10 000步即能满足每周至少150 min中高强度身体活动推荐量的要求，因此建议以12 000步作为青少年儿童的身体活动推荐量标准，7 000-10 000步作为老年人和特殊人群身体活动量推荐标准[28-30]。但到目前为止，并未有官方的、标准的、通用的智力障碍者身体活动推荐量标准，因此归纳文献，发现文献中使用的推荐量有多样性的特点：每天不少于60 min中高强度身体活动，每周不少于 150 min中高强度身体活动，每天不少于7 500、10 000步和12 000步，5 d不少于50 000步等。梳理文献中智力障碍者满足身体活动推荐量的人数比例发现：总体而言，0%-43%的青少年儿童能满足每天不少于60 min中高强度身体活动的推荐量[31-37]，10%能满足每天不少于12 000步的推荐量[38]，分别有26%和22%的男生和女生能满足5 d不少于50 000步的推荐量[39]。0%-2%的智力障碍成年人能满足每周不少于150 min中高强度身体活动的推荐量[32，36，40]，15.3%-35.1%能满足每天不少于10 000步的推荐量[32，41-44]，37.2%能满足每天不少于7 500步的推荐量[44]，见表1。"

进一步深入分析，发现无论是青少年儿童还是成年人，满足推荐量的人数远少于同龄健全人[33，36，39]；男性满足推荐量的人数都高于女性[33，39，45]；工作日能满足推荐量的人数多于周末[33，46]；低龄组能满足身体活动推荐量的人数多于高龄组[34，37]；在没有满足推荐量的人群中，超重者所占比例大于正常体质量者就遗传因素造成染色体异常的智力障碍者而言[20]，满足推荐量的人数最多的是普瑞德威利症候群(Prader-Willi syndrome，PWS)组，最少的是唐氏综合征组[45]。 2.3 智力障碍者身体活动与健康的关系梳理纳入文献发现智力障碍者身体活动与健康的关系研究主要是身体活动水平与肥胖、心血管功能的关系，具体的指标包括体质量指数、脂肪百分比(%fat)、腰围、最大耗氧量(VO2peak)、血压等，其中讨论最多的是身体活动与体质量指数的关系[39，43，47-50]。结果发现，与健全人研究不同，虽然智力障碍者的身体活动水平与体质量指数、腰围、脂肪率呈负相关关系，与VO2peak呈正相关关系，但相关系数低且都不具有显著性差异，分析原因可能与智力障碍者研究的样本量小有关[39，47-50]。Stanish等[43]与他人研究基本相符，但也有不同的发现：将智力障碍者的步行水平分为少于5 000步、 5 000-7 499步、7 500-9 999步、不少于10 000步4个等级，其他3个步行水平等级，智力障碍者的血压、体质量指数和腰围与身体活动水平正相关，但步行不少于10 000步的智力障碍者组却相反，呈负相关，探索原因可能是后者生活独立性较强，可以自由挑选他们喜欢的食物，摄入高脂肪含量的食物较多，致使血压更高，体质量指数和腰围值更大。因此对自主、独立能力较强的智力障碍者，照顾者应加强科学的膳食管理。综上可见，智力障碍者身体活动水平总体上与健康指标的相关系数都较低，且不具有显著性。但这并不表明智力障碍者的身体活动水平与健康之间不存在关系。当前智力障碍者身体活动与健康的关系都是通过横向研究来分相关性，然而无论是肥胖还是心血管机能的影响因素都是多样化，除了身体活动之外，基因、膳食习惯、遗传、疾病等也都是关键影响因素，因此仅通过横向研究来建立的智力障碍者身体活动水平与健康的关系是有限制的。未来研究需加强纵向研究，通过长期跟踪，建立动态的身体活动行为与肥胖、心肺功能及慢性疾病的关系，如智力障碍者青少年儿童时期身体活动水平低，是否成年和中年后肥胖和慢性疾病的发生率高，最终确立身体活动水平预测疾病的程度，建立身体活动水平与健康的关系。 2.4 智力障碍者身体活动参与的影响因素探索智力障碍者身体活动参与的促进和阻碍因素，对身体活动水平改善方案的设计具有针对性意义。智力障碍者身体活动参与的影响因素总体上可以归纳为个人因素、社会因素和环境因素[51]，见图2。"

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