The Role of the Nurse Practitioner in Promoting Physical Activity in People with Intellectual and Developmental Disabilities
Individuals with intellectual and developmental disabilities (IDDs) are living longer than their peers from previous generations. However, these individuals still experience a myriad of health conditions from several negative determinants of health such as poor health behaviors, unwelcoming environments, social circumstances, and poor access to health care. Individuals with IDDs are often among the most underserved populations, having higher levels of obesity than the general population, resulting in higher rates of morbidity and mortality. An article by Marks and Sisirak, in the January 2017 issue of The Journal for Nurse Practitioners, tackles the issue of reversing these poor health indicators by helping individuals with IDDs become more physically active. They argue that nurse practitioners (NPs) are uniquely positioned to improve the health and functional outcomes of this patient population through their work. Through this article, they hoped to raise awareness of what NPs can do to promote physical activity (PA) in individuals with IDDs and help them overcome the barriers that they face.
Individuals with IDDs face multiple barriers to engaging in physically active lifestyles. Many times, health professionals conflate disability with health status and view these patients as being “sick”. This results in an under-emphasis on health promotion and disease-prevention activities, such as promoting regular PA. Healthcare providers are trained to deal with the acute needs of these individuals, leaving them to “operate without a map” with this patient population that has unique needs and interaction styles. Further, racial and ethnic barriers result in poorer health care that is exasperated by a lack of adequate transportation and living in low-income communities. The result - low to no expectations for individuals with IDDs to engage in regular PA.
However, there is promise on the horizon. Evidence-based health promotion programs are showing improvements in physiological, fitness, and psychosocial outcomes. The Team Up For Fitness in Newton, MA, involves certified trainers developing and supervising workout programs for their clients and peer “work-out buddies”. The Stay Well and Healthy! program provides guidance to in-home nurses to provide preventive care and encourage PA to individuals with IDDs, while the Peer to Peer HealthMessages program is an evidence-informed program that trains and provides resources for healthy lifestyle coaches working with individuals with IDDs. Perhaps the best known program for individuals with IDDs is the Special Olympics, which seeks to raise awareness about the abilities of people with intellectual disabilities and engage them in physical activity and sport.
NPs can contribute to these efforts by ensuring that they recommend PA as a part of their daily practices to all individuals with IDDs. Electronic health records can identify clients with special needs, support collaborative efforts and improve communication between providers, and link multidisciplinary teams providing care for the individual. By using multimodal descriptions of PA that include concrete language with visuals, explanations, and demonstrations to increase comprehension, NPs can increase patient understanding of PA and increase their autonomy in making more informed decisions. Other strategies available to NPs include better transmission and interpretation of nonverbal communication strategies, using technological aids as viable options to enhance participation in leisure activities, and using online tools, programs, and resources to ensure that patients with IDDs, and their caregivers, have the necessary support to become more physically active. Outside of the clinic setting, NPs can integrate PA into school-based clinics and worksite wellness activities. Lastly, through community engagement and equity activities, NPs can use their influence to expand the promotion of resources and programs for individuals with IDDs beyond individual-level approaches offered only in the clinic setting.
Marks B & Sisirak J. Nurse Practitioners Promoting Physical Activity: People With Intellectual and Developmental Disabilities. J Nurse Practitioners. 2017; 13(1):e1-e5.