Comparing the effect of three exercise and wellness programmes on balance and fall prevention in physically inactive adults with learning disabilities

INTERVENTION: The Special Olympics (SO) Slovenia programme provided a list of all adult athletes in their programme who, despite the designation, were physically inactive (?600 median minutes/week); SO Games Management System software and HAP FF data were used for this purpose. The list of 180 Special Olympics athletes with intellectual disabilities (ID) who are categorized as being inactive and having a high fall frequency (1 fall or more in the past 4 months) was derived from the HAP FF data (in October 2017 for inactive adults with ID and with fall history) compiled of all 1674 (both physically inactive and active) Slovenian SO athletes older than 18 years. PA (physical activity) level was determined according International Physical Activity Questionnaire – long form. The stratified random sampling was used for recruitment using the Slovenian SO database (SO Games Management System software) and HAP FF data. A randomization list was prepared by the independent statistician using random permuted blocks. This technique ensured that equal numbers of inactive adults with ID within each stratum were randomized to each intervention (restricted stratified randomization). All 150 participants were randomly selected from predetermined strata that correlated with variables in the study (from 79 national SO member programmes within Slovenia, representing both urban and rural areas across all geographic regions in Slovenia). An important feature of stratified randomization was the use of random permuted blocks, which ensured that equal numbers of adults with Down syndrome, cerebral palsy, autism spectrum disorder, Prader Willi syndrome, attention deficit hyperactivity disorder, and others with mild and moderate ID within each stratum were randomized to each intervention group. Stratification of variables known to influence outcome was carried out in our RCT design. Stratified randomization procedures have taken athletes’ characteristics into account in ord CONDITION: Physically inactive adults with intellectual disabilities who have poor balance and a history of falls ; Injury, Occupational Diseases, Poisoning PRIMARY OUTCOME: Frequency of falls at baseline (i.e. prior to randomization) and 16 weeks after randomization SECONDARY OUTCOME: Static and dynamic balance tested using the Fun Fitness battery test (a functional reach test and a single leg stance test with eyes opened/closed; Bainbridge et al., 2013) at baseline (i.e. prior to randomization) and 16 weeks after randomization. . The functional reach test was done 1 hour after the physical activity programme in order to avoid the influence of tiredness. All the assessments were carried out individually in well‐lit, quiet, air‐conditioned rooms. INCLUSION CRITERIA: 1. Adults aged =18 years 2. Mild or moderate ID (ID is diagnosed using medical data) 3. Physically inactive (do not reach the World Health Organization recommendations on weekly physical activity level) 4. Experienced one or more falls in the 4 months previous to the study 5. No restraints in terms of World Health Organization recommendations on physical activity (i.e. with mandatory general practitioner clearance to participate in a physical activity programme 6. Ambulatory (i.e. able to walk independently) 7. Ability to consent – potential participants were either judged by their SO coach to be competent to give informed consent or had a guardian with power of attorney. The ID individuals or their legal guardians had given informed consent in writing. If a guardian signed informed indicated consent but the individual with ID did