Purpose: The purpose of this trial was to compare the effectiveness of two diets [Enhanced Stop light (eSLD) vs. conventional (CD)] and two delivery strategies [face-to-face (FTF) vs. remote (RD)] across an 18 month weight management program (6 mos. weight loss, 12 mos. maintenance) in adolescents with intellectual disabilities (ID) who were randomized to one of 3 arms: FTF/CD), RD/CD, RD/eSLD.

Methods: Adolescents and a parent attended individual behavioral sessions delivered via FTF home visits or remotely using FaceTime^TM twice/month (0-12 months) and once/month during months 13-18. The eSLD used the Stop Light guide which categorizes foods by energy content: green (low energy-eat freely), yellow (moderate energy-eat sparingly), and red (high energy-avoid) which was enhanced by encouraging consumption of low energy portion-controlled entrées and shakes and fruits/vegetables. The CD was a nutritionally balanced, reduced energy diet following U.S. dietary guidelines. Participants were also asked to increase their physical activity, and to self-monitor diet (RD: diet app, FTF: paper diary), physical activity (RD: wireless tracker, FTF: pedometer) across the 18-mo. intervention.

Results: One hundred and ten adolescents with ID (53% female, age ~16 yrs) were randomized to either the FTF/CD (n=36), RD/CD (n=39), or RD/eSLD (n=35) arms. Weight was obtained from ~92% and ~82% of participants at 6 and 18 mos., respectively. Weight loss was significantly greater using the eSLD compared with the CD at 6 months (RD/eSLD: -5.0±5.9kg vs. RD/CD: -1.8±4.0kg; p=.01) but not at 18 mos. (RD/eSLD:-2.2±7.4kg vs.  RD/CD: -0.2±6.6kg; p=0.28). There were no significant differences in weight loss between FTF and RD at either 6 (FTF/CD: -0.3±5.0 kg vs. RD/CD: -1.8±4.0kg; p=0.20) or 18 mos. (FTF/CD:1.4±9.7kg vs. RD/CD: -0.2±6.6kg; p=0.47). The percentage of behavioral sessions attended (FTF/CD=76%, RD/CD=71%, RD/eSLD=71%), the percentage of days of self-monitoring of diet (FTF/CD=67%, RD/CD=61%, RD/eSLD=61%), and self-monitoring MVPA/steps (FTF/CD=66%, RD/CD=62%, RD/eSLD=62%) did not differ significantly between by diet or delivery strategy across 18 months (all p>0.05) 

Conclusions: An eSLD, delivered remotely, results in clinically relevant weight loss in adolescents with ID. However, future research is required to identify effective strategies to maintain this weight loss long-term.  

Background: Autistic youth experience significant barriers to physical activity (PA) program engagement, including a lack of safe and tailored community programming and depleted parental resources. Using the Physical Activity Engagement for Invisible Social, Emotional, and Behavioral Disabilities (PAID) Framework, we adapted GamerFit-ASD for autistic youth with or without co-occurring intellectual disabilities from an existing theory- and evidence-based exergaming and telehealth coaching intervention, and pilot tested it for feasibility, acceptability, accessibility, and preliminary efficacy. 

Methods: Following an iterative adaptation process that included autistic youth and their families, graduate student coaches were trained by professional health coaches and an autistic consultant to implement the intervention. The 12-week single-arm demonstration pilot recruited youth ages 10-15 years from community programs serving autistic youth and their families. Participants wore a Fitbit, followed a 3-times/week exergaming program, and met with their health coach weekly. Graduate student coaches were overseen by professional coaches for the first three weeks of the program.  Accelerometry data were collected at baseline and week 12. Feasibility and engagement were assessed with process measures. Questionnaires measured video game use and participant mood. Paired t-tests were used to assess PA, video gaming and mood changes. 

Results: 23 participants enrolled (average age 11.6 years; 78% male-identified; 83% white; 17% with a potential co-occurring intellectual disability). Coaching session attendance was 92%; on  average, participants completed 67% of exergaming sessions/week, 78.5 minutes/week of exergaming, and 6645 steps/day. Most youth reported enjoying the exergames (72%) and intending to keep playing them (67%); 94% reported it was easy to learn the games; and 79% of parents reported it was easy to participate. Total PA trended towards an increase of approximately 1 hour per week (p=0.35), but changes were not statistically significant. Self-reported video game use excluding exergaming decreased by 50 min/day (p=0.10), but self-reported mood did not change. 

Conclusions: GamerFit-ASD was feasible, acceptable, and accessible for use increasing PA among these participants, however additional feasibility testing should be conducted in a sample with more participants with intellectual disabilities. Effectiveness should be evaluated via an RCT with a larger, more diverse sample.

Purpose:  Youth with intellectual disabilities (ID) are known to have low physical activity levels and poor diet quality. Physical and food literacy are thought to support adoption of healthy lifestyles; however, few interventions have been developed for this population.  Physical and food literacy are concepts that encompass skills, confidence, knowledge, and desire to engage in physical activity and make healthy food choices.  The “New Skills/No Scores” intervention was developed to build physical and food literacy skills among adolescents with ID.

Methods: Participants with ID ages 12-16 years were recruited for a 12-week sports skills and nutrition education intervention.  Program sessions and all measures were administered via Zoom by trained instructors.  Weekly sessions comprised 35 minutes of sport skills training to build physical literacy, followed by a 35-minute food literacy lesson involving nutrition education activities and taste testing.  Feasibility, acceptability, and preliminary efficacy were assessed by attendance, satisfaction, and pre-post measures of motor skills, physical self-concept, motivation and confidence for physical activity, classifying foods, making healthy choices, and food consumption. 

Results: Six teens participated in the program and attended 87.5% of the sessions. Satisfaction data suggested that the program was well-received by both teens and parents. Trends toward improvements on physical literacy and food literacy outcome measures were observed.

Conclusions: Preliminary data suggest that a remotely-delivered physical and food literacy program tailored to youth with ID is promising for building the skills, confidence, and motivation that underpin healthy lifestyle choices.

Building physical and food literacy may have promise for contributing to the adoption of healthy lifestyles in youth with ID.