Research aims to promote healthier habits in people with intellectual disabilities in residential group homes
When we want to go to the store, most of us lace up our sneakers, grab our car keys and head out the door. But for people with intellectual disabilities living in residential group homes and supported independent living settings, barriers such as staffing or policies, aimed at promoting safety, can make it more challenging to participate in that kind of regular movement that’s beneficial to one’s overall health.
“I’ve always been interested in promoting health through leisure activities or things we already like to do,” Paige Laxton said. “Too often, the focus is on physical activity and how we get people to moderate-vigorous exercise for at least 30 minutes a day. But that’s not always sustainable for this population.”
Laxton observed this firsthand while working as a day program manager at a residential group home in Pennsylvania.
“I saw the gap between people actively participating in the program and then being more sedentary in their home environments,” she said.
Now, the third-year doctoral candidate in the health behavior science and promotion program in the University of Delaware’s College of Health Sciences, wants to create healthier homes for people with intellectual disabilities.
“I have a passion for getting people more involved in their own health and helping them become more active — no matter their disability — and ensuring they’re a part of the solution and invested in the outcome versus able-bodied people telling them what to do,” Laxton said.
Her adviser, Freda Patterson, a professor of behavioral health and nutrition, said Laxton was perfectly poised to lead this study.
“Paige brought such a wealth of clinical experience in her previous work with adults with intellectual disabilities,” said Patterson. “This is part of what sets us apart from other disciplines in the College of Health Sciences. We prepare our students to do community needs assessments, and Paige brought that experience to her studies already.”
Best practices in aging have evolved with the trend in recent decades focusing on transitioning people with intellectual disabilities from institutional settings to community living settings so they feel empowered and can have the opportunity for more everyday life experiences.
“We need to ensure that these community living homes are healthier and that their caregivers feel comfortable sending them there as well,” Laxton said.
Through research and data collection, Laxton is seeking to characterize patterns of sedentary behavior, which includes time spent relaxing on the couch while watching TV or scrolling on a cellphone, or at a desk surfing the web.
To measure this, she’ll equip residents of KenCrest adult community living homes, based in Pennsylvania, who volunteered to take part in the study, with an activPAL, an inclinometer that measures postural movements. The device, worn on the thigh for a week, is considered the gold standard for monitoring sedentary behavior but has rarely been used in people with intellectual disabilities.
Laxton wants to learn what sedentary patterns look like in this understudied population and what factors influence those behaviors from interpersonal motivations to organizational barriers. Direct support staff, who provide one-to-one care to people with intellectual disabilities, will also wear the device.
“We want to monitor interactions between peers, roommates, and staff who might influence each other. If one is going for a walk, maybe another will too,” Laxton said.
Her research will lay the groundwork for future interventions.
“If we break up our sedentary activity even for a couple minutes every hour or for a 30-minute timeframe, it has great benefits for our cardiovascular health and other health outcomes, and it may be an easier, more attainable target for people with intellectual disabilities,” Laxton said. “Small changes like moving from sitting to light physical activity such as walking may have a beneficial impact on a person’s health across time.”
One of Laxton’s goals is to implement interventions that lessen pressure on overworked and under-resourced direct support staff and caregivers. Patterson is intrigued by this aspect of Laxton’s research.
“There is not room for one more thing on most caregivers’ plates,” Patterson said. “I am most excited about learning from Paige’s work what we can do at the micro-level in terms of how residential home environments are built and designed, so that we can reduce sedentary time with little to no human investment needed.”
Julie Daly, director of enabling technologies for KenCrest, called their relationship with Laxton and UD’s Department of Behavioral Health and Nutrition the “perfect partnership.”
“I’m on an innovative team that uses technology to support people in home- and community-based settings, but we don’t always have the support to collect the data that could contribute to groundbreaking research like this,” Daly said. “For us, these collaborative partnerships are really valuable.”
Daly said residential services have been impacted by a variety of factors, including staffing. But she’s looking forward to the intervention stage of the research so KenCrest can implement environmental changes that promote healthier habits and empower residents.
“When we have a better understanding of these measures of sedentary behavior, we can make changes within the group home environment that will allow people to engage in less sedentary behavior,” Daly said.
Laxton is excited for the intervention stage as well.
“I would love to see us understand movement behaviors in this group so that we can better serve them,” Laxton said. “Ultimately, I’d like to see technology used in the home to decrease sedentary behavior.”
Daly, who’s been with KenCrest for more than 20 years in various roles, is also proud that people with intellectual disabilities have a voice in this project.
“People with intellectual disabilities haven’t always been included in the solutions that are directed at them,” Daly said. “So, I see a lot of value in offering them an opportunity to participate in research about them and solutions that are going to impact them.”
During her time in the doctoral program, Patterson has watched Laxton grow as a scholar.
“She’s now leveraged her knowledge of the lives and challenges faced by adults with intellectual disabilities to formulate research questions and a robust study methodology that we hope will give the information needed to develop strategies and policy to reduce sedentary time in this context,” Patterson said.
As a doctoral candidate, Laxton will only see this research through the assessment stage. But she plans to follow the project through the intervention stage. The magnitude and scope of her work has the potential to have long-lasting effects.
“We know that the features of our built environment such as streetscapes and access to parks and green space play a role in physical activity. Paige’s work parallels this paradigm by seeking to understand how home and micro-environments influence sedentary behavior,” Patterson said. “Paige’s dissertation could be a springboard for further inquiry and a career in research.”