View in EDS HTML Full Text PDF Full Text

A Six-Month Nordic Walking Program for Adults with Intellectual and Developmental Disabilities: Feasibility and Effect

Saved in:
Bibliographic Details
Title: A Six-Month Nordic Walking Program for Adults with Intellectual and Developmental Disabilities: Feasibility and Effect
Language: English
Authors: Ayelet Dunsky (ORCID 0000-0002-9228-7007), Sharon Barak (ORCID 0000-0003-0714-4798)
Source: Journal of Applied Research in Intellectual Disabilities. 2025 38(3).
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 10
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Descriptors: Physical Activities, Intellectual Disability, Adults, Physical Activity Level, At Risk Persons, Chronic Illness, Developmental Disabilities, Psychomotor Skills, Physical Mobility, Physiology, Environment, Emotional Development, Intervention, Muscular Strength, Outcomes of Treatment, Health Promotion, Physical Health
DOI: 10.1111/jar.70063
ISSN: 1360-2322
1468-3148
Abstract: Background: Individuals with intellectual and developmental disabilities tend to engage in low levels of physical activity, which puts them at risk for chronic health conditions, poor balance and gait difficulties. Nordic walking could improve gait, balance, strength, endurance and respiratory function while enjoying nature. Method: Thirty-four adults with intellectual and developmental disabilities were assessed for physical performance and emotional status before and after participating in a six-month intervention comprised of weekly Nordic walking sessions. Five staff members were also interviewed about the programme. Results: Nordic walking was found to be feasible, with an average monthly attendance of 60.75%. Following the intervention, significant improvements were seen in lower-extremity strength, flexibility and waist-to-hip ratios. Conclusions: Nordic walking motivates participants to engage in physical activity, strengthens muscles, and increases flexibility. Thus, people who work with adults with intellectual and developmental disabilities may consider including Nordic walking in their health enhancement and maintenance programmes.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1474917
Database: ERIC
Full text is not displayed to guests.
FullText Links:
  – Type: pdflink
    Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwEg6reOuy7slT7a_MmNr6ioAAAA4zCB4AYJKoZIhvcNAQcGoIHSMIHPAgEAMIHJBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDKJf92K_R0qSS1R0JgIBEICBm7Pg3QXTL5ueBy0RZz2lsu8EoQvjhc_q8khnwoWkaO_BPmdU_UESWLxk6xe_lGLMWHC4J9fC4Jf9EE5pHHUcxQ4ns1-0Pk5dE7c-4Zm76u3fS3ECxtc4Z5hMMztO5p7vsFhESBrMkwIWf6h_DhRT5HX4-La3dvH_CGo3gxa4QEdBhAKQQ1hcLNDRsvCQgNr2KjBU7a_v7eAlK7aJ
Text:
  Availability: 1
  Value: <anid>AN0186163430;e0301may.25;2025Jun27.04:03;v2.2.500</anid> <title id="AN0186163430-1">A Six‐Month Nordic Walking Program for Adults With Intellectual and Developmental Disabilities: Feasibility and Effect </title> <p>Background: Individuals with intellectual and developmental disabilities tend to engage in low levels of physical activity, which puts them at risk for chronic health conditions, poor balance and gait difficulties. Nordic walking could improve gait, balance, strength, endurance and respiratory function while enjoying nature. Method: Thirty‐four adults with intellectual and developmental disabilities were assessed for physical performance and emotional status before and after participating in a six‐month intervention comprised of weekly Nordic walking sessions. Five staff members were also interviewed about the programme. Results: Nordic walking was found to be feasible, with an average monthly attendance of 60.75%. Following the intervention, significant improvements were seen in lower‐extremity strength, flexibility and waist‐to‐hip ratios. Conclusions: Nordic walking motivates participants to engage in physical activity, strengthens muscles, and increases flexibility. Thus, people who work with adults with intellectual and developmental disabilities may consider including Nordic walking in their health enhancement and maintenance programmes.</p> <p>Keywords: feasibility; health risks; intellectual and developmental disabilities; motivation for physical activity; Nordic walking</p> <p></p> <ulist> <item> Adults with intellectual and developmental disabilities engage in low levels of physical activity and are at risk for chronic health conditions.</item> <p></p> <item> Nordic walking is an outdoor activity that improves lower‐extremity strength, flexibility, and waist–hip ratios.</item> <p></p> <item> Nordic walking is feasible for adults with intellectual and developmental disabilities.</item> </ulist> <p>Summary</p> <hd id="AN0186163430-2">Introduction</hd> <p>Individuals with intellectual and developmental disabilities are more likely to develop cognitive degenerative processes that are characteristic of ageing, including anxiety and dementia (Lin et al. [<reflink idref="bib24" id="ref1">24</reflink>]), as well as physical deficits, including poor balance, posture and gait performance (Carmeli and Imam [<reflink idref="bib7" id="ref2">7</reflink>]). In addition, chronic health conditions, such as respiratory disorders, are known to be a leading cause of death among individuals with intellectual disabilities (Truesdale et al. [<reflink idref="bib40" id="ref3">40</reflink>]). One possible underlying factor for these undesirable challenges could be the sedentary lifestyles of adults with intellectual and developmental disabilities, who do not usually meet the minimum recommendations for performing daily and weekly physical activity, as defined by a range of health organisations, such as the WHO ([<reflink idref="bib43" id="ref4">43</reflink>]) and the American College of Sports Medicine (ACSM) (Emerson [<reflink idref="bib15" id="ref5">15</reflink>]; Hsieh et al. [<reflink idref="bib18" id="ref6">18</reflink>]; Liguori and ACSM [<reflink idref="bib23" id="ref7">23</reflink>]).</p> <p>A sedentary lifestyle has been found to lead to low levels of physical fitness (presented by low cardiovascular fitness, muscular endurance, muscular strength, flexibility, and balance, thus preventing individuals from the ability to carry out daily tasks without undue fatigue). Low levels of physical fitness may pose a significant risk factor for cardio‐metabolic conditions, as well as type II diabetes, insufficient bone mineral content and premature mortality (Dunstan et al. [<reflink idref="bib14" id="ref8">14</reflink>]; Temple et al. [<reflink idref="bib38" id="ref9">38</reflink>]; Tremblay et al. [<reflink idref="bib39" id="ref10">39</reflink>]). Indeed, adults with intellectual and developmental disabilities show a considerable lack of physical fitness (mainly assessed by lower limbs muscular strength, muscular endurance, balance, and flexibility), as well as deficient levels of cardiovascular endurance—compared to peers without disabilities (Jacob et al. [<reflink idref="bib20" id="ref11">20</reflink>]; Lotan et al. [<reflink idref="bib27" id="ref12">27</reflink>]; Obrusnikova et al. [<reflink idref="bib31" id="ref13">31</reflink>]).</p> <p>It is troubling that adults with intellectual and developmental disabilities perform less physical activity than peers without disabilities; not only is physical activity especially beneficial for the former's physical and mental health, but it is also known to positively impact aerobic capacity, gross motor functions, balance, muscle strength and quality of life in these adults (Bartlo and Klein [<reflink idref="bib3" id="ref14">3</reflink>]; Johnson [<reflink idref="bib21" id="ref15">21</reflink>]). Since many adults with intellectual and developmental disabilities are under the care of public authorities, the duty to protect their rights and health is of utmost importance. Thus, researchers suggest a range of programs for promoting engagement in physical activity to improve their physical fitness, such as daily treadmill (Lotan et al. [<reflink idref="bib26" id="ref16">26</reflink>]), virtual reality (Lotan et al. [<reflink idref="bib27" id="ref17">27</reflink>]), indoor bike cycling and exergaming (Martinez‐Millana et al. [<reflink idref="bib29" id="ref18">29</reflink>]) and with an emphasis on increasing their motivation to participate (Lotan [<reflink idref="bib25" id="ref19">25</reflink>]).</p> <p>Increased physical activity has been seen among individuals with intellectual and developmental disabilities following support from others and through activities that were enjoyable, meaningful or part of a routine (Dixon‐Ibarra et al. [<reflink idref="bib12" id="ref20">12</reflink>]; Jacob et al. [<reflink idref="bib20" id="ref21">20</reflink>]). On the other hand, a range of medical and physiological factors was found to hinder physical activity, as well as transportation issues, costs, lack of personalised support and lack of physical activity programmes in the community (Dixon‐Ibarra et al. [<reflink idref="bib12" id="ref22">12</reflink>]; Jacob et al. [<reflink idref="bib20" id="ref23">20</reflink>]; Mahy et al. [<reflink idref="bib28" id="ref24">28</reflink>]).</p> <p>Nordic walking is one safe and motivational form of physical activity for adults with intellectual and developmental disabilities. Using Nordic poles expands the walker's base of support, increases stability, and activates both the upper and lower parts of the body. This exercise also increases training intensity without creating excessive overloading on the lower extremities. Thus, Nordic walking may improve gait, balance, strength, endurance and respiratory functions while walking in nature (Tschentscher et al. [<reflink idref="bib41" id="ref25">41</reflink>]).</p> <p>However, studies are lacking on long‐term physical activity programs among adults with intellectual and developmental disabilities that strive to increase their engagement in physical activity and, in turn—improve their physical fitness (Frey et al. [<reflink idref="bib17" id="ref26">17</reflink>]; St. John et al. [<reflink idref="bib35" id="ref27">35</reflink>]). The aim of the current study was to evaluate the feasibility of a six‐month Nordic walking intervention for adults with intellectual and developmental disabilities and assess the program's effect on their physical fitness, health‐related risks, motivation to participate, and emotional status.</p> <hd id="AN0186163430-3">Methods</hd> <p></p> <hd id="AN0186163430-4">Study Design</hd> <p>The study included two data collection phases: <emph>T0</emph>, pre‐intervention, and <emph>T1</emph>, post‐intervention, and a six‐month intervention phase.</p> <hd id="AN0186163430-5">Ethical Conduct</hd> <p>The study was approved by the Ethics Committee at the Academic College at Wingate (00932016). Each participant and a legal guardian signed and submitted an informed written consent form. The participants' health, safety, and confidentiality were protected throughout the study.</p> <hd id="AN0186163430-6">Participants</hd> <p>The Nordic walking intervention involved 100 adults with intellectual and developmental disabilities who visited a designated club between once and three times a week. The program was run by 'AKIM'—an Israeli nationwide organisation for people with intellectual and developmental disabilities, and conducted in small groups in nine different locations. Fifty participants were included in the study presented in this article, offering a representative sample. More specifically, stratified random sampling was used to select 50 participants from the 100 adults with intellectual and developmental disabilities attending the program. Stratification was based on key demographic factors, including age, sex, and living area, to ensure the sample reflected the diversity of the broader population. This approach ensured proportional representation across all strata, maintaining the demographic characteristics of individuals with intellectual and developmental disabilities in the country.</p> <p>All participants had been previously diagnosed with an intellectual and developmental disability, in line with definitions published by the State of Israel—Ministry of Special Education ([<reflink idref="bib36" id="ref28">36</reflink>]); their disability had also been categorised as either mild, moderate, or severe—depending on the degree of support that they required for performing academic, work and life functions.</p> <p>Of the 50 participants initially included in the study, 34 (70.58% male) completed all study parts (two assessments and the intervention), with a mean age of 34.10 ± 9.27 years (i.e., the study group). The additional 16 participants did not attend the final assessment session for various reasons, including illness or work (i.e., the non‐complete assessment group).</p> <hd id="AN0186163430-7">Power Analysis</hd> <p>A priori power analysis for the mean difference from <emph>T0</emph> to <emph>T1</emph> was conducted using the observed sample effect size as the basis of the population effect from a previous study conducted on a similar population (Hutzler et al. [<reflink idref="bib19" id="ref29">19</reflink>]; test family: <emph>t</emph>‐tests; and statistical test: the mean difference between two dependent means). The analysis showed that when using the mean effect size of the change observed in the study's primary outcome measures (i.e., fitness measures and waist‐to‐hip ratios; mean effect size = 0.50), with a sample size of <emph>n</emph> = 34, two‐tail test and the alpha error set at 0.05, the power in this study was 0.807. A sample of 50 participants was assessed at <emph>T0</emph> to address potential dropouts.</p> <p> <emph>P</emph>‐values < 0.05 (two‐tailed) were considered significant in all statistical analyses. Most statistical analyses were conducted by SPSS v. 23 (SPSS Inc., Chicago, Ill., USA). Power analysis was conducted using G*Power 3.0.10 (Faul et al. [<reflink idref="bib16" id="ref30">16</reflink>]).</p> <hd id="AN0186163430-8">The Intervention Program</hd> <p>The Nordic walking program took place once weekly. Each session was conducted outdoors for 40–50 min, guided by professionally trained instructors. The sessions comprised a light 5‐min warm‐up, followed by 30–40 min of Nordic walking through a park, and ending with a light 5‐min relaxation. As the participants became more accustomed to the training, the Nordic walking increased in difficulty (i.e., walking on different paths uphill, overcoming obstacles, etc.) and distance. The instructors asked the participants to pay attention to their posture, use force when placing their poles on the ground, inhale when the pole is in the air and then slowly exhale when placing it on the ground. Special attention was also paid to the environment; the outdoor nature of the Nordic walking enabled the instructors to improve the participants' involvement and engagement (Lahart et al. [<reflink idref="bib22" id="ref31">22</reflink>]). The instructors chose different routes for each session, emphasising exciting landscapes and directed the participants' attention to the flora and fauna they could see.</p> <hd id="AN0186163430-9">Outcomes</hd> <p></p> <hd id="AN0186163430-10">Quantitative Assessments</hd> <p>These evaluations include anthropometric, fitness, metabolic health condition and enjoyment tests:</p> <hd id="AN0186163430-11">Anthropometric Measures</hd> <p>These included an assessment of weight (kg) and height (m<sups>2</sups>), and the body mass index (BMI) was then calculated. At <emph>T0</emph>, the participants' disability levels were also documented, and demographic data were collected, including age, gender, family status, number of children and religiousness. This information was provided by the participants' legal guardians, family members or the organisation's management.</p> <hd id="AN0186163430-12">Fitness Assessments</hd> <p>The following five were also conducted at both time points: (<reflink idref="bib1" id="ref32">1</reflink>) 2‐min walk test; (<reflink idref="bib2" id="ref33">2</reflink>) standing long‐jump test; (<reflink idref="bib3" id="ref34">3</reflink>) 30‐s sit‐to‐stand test; (<reflink idref="bib4" id="ref35">4</reflink>) 30‐s sit‐ups test; and (<reflink idref="bib5" id="ref36">5</reflink>) sit‐and‐reach test.</p> <p>To ensure that participants understood the correct performance, the tester demonstrated it before each of the following tests. Then, the participant performed one trial to practise and verify the correct technique, followed by one maximal performance for the assessment.</p> <p> <emph>The 2‐min walk test</emph> is used to assess cardiovascular fitness. For this test, the participants were asked to walk as far as they could for 2 min without stopping or using any assistance. Their total walking distance was recorded (Selman et al. [<reflink idref="bib33" id="ref37">33</reflink>]).</p> <p>The <emph>standing long‐jump test</emph> is used to assess lower‐extremity power. For this test, the participants were asked to place their feet slightly over the edge of the sandpit, crouch down, lean forward, swing their arms backward and then swing them forward while jumping as far forward as possible, landing on both feet. The jumping distance was measured from the edge of the sandpit where the participants began the test to the feet's first point of contact with the ground following the jump (Skowroński et al. [<reflink idref="bib34" id="ref38">34</reflink>]).</p> <p>The <emph>30‐s sit‐to‐stand test</emph> is used to assess leg strength and endurance. For this test, the participants were asked to sit on a chair in the centre of the seat, hands crossed over and placed on the opposite shoulders while keeping their feet flat on the floor, back straight, and arms against their chest. The participants were asked to repeatedly stand up straight and sit on the chair for 30 s after hearing the word 'go'. The number of complete standing positions was documented (Centers for Disease Control and Prevention [<reflink idref="bib8" id="ref39">8</reflink>]). <emph>The 30‐s sit‐up test</emph> is used to assess abdominal muscle endurance. For this test, the participants were asked to lie on a mat on the floor, knees at a right angle, feet held firmly on the floor by a partner, fingers interlocked behind their head. Upon hearing the word <emph>go</emph>, they were to perform as many sit‐ups as possible within 30 s, repetitively raising their chest upwards and then lying back down with their head touching the floor (Yanardag et al. [<reflink idref="bib45" id="ref40">45</reflink>]).</p> <p> <emph>The sit‐and‐reach test</emph> is used to assess lower‐extremity flexibility. For this test, the participants were asked to sit on the floor with their legs stretched straight ahead, with the soles of their feet placed vertically against a measuring box, feet slightly apart at about hip‐width. The participants were then instructed to extend their hands as far forward as possible while keeping their knees straight. A standard ruler was placed on the sit‐and‐reach box to standardise measurements and reduce variability, starting at 23 cm from the heel. Only reaching beyond the toes was recorded as positive. All scores were documented in cm and rounded up or down to the nearest 0.5 cm (Cooper [<reflink idref="bib11" id="ref41">11</reflink>]; Skowroński et al. [<reflink idref="bib34" id="ref42">34</reflink>]).</p> <hd id="AN0186163430-13">Metabolic Health Conditions</hd> <p>In addition to these five physical tests detailed above, <emph>waist‐to‐hip ratios</emph> were measured at both time points to assess the participants' metabolic health risks. For this measurement, the participants were asked to remain standing; measurements were taken directly over the skin or tight clothing. The width of the waist was measured at the narrowest part of the body (about 2–3 cm above the navel); the width of the hip was measured at the broadest part of the buttocks (about 2–3 cm below the navel). The ratio was calculated by dividing the waist circumference by the hip circumference (Cooper [<reflink idref="bib11" id="ref43">11</reflink>]).</p> <hd id="AN0186163430-14">Emotional Status</hd> <p>Participants' general emotional status levels were assessed at both time points using four aspects of emotions (using representative images) and a 5‐point scale. This resulted in a total score for each participant ranging from 4 to 20, as shown in Figure 1. This scale was used because it was hypothesised that being physically active outdoors with peers would enhance physical fitness and emotional status.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/E03/01may25/jar70063-fig-0001.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="jar70063-fig-0001.jpg" title="1 Emotions monitoring card." /> </p> <p></p> <hd id="AN0186163430-16">Program Feasibility</hd> <p>The feasibility of the six‐month program was evaluated based on one parameter representing feasibility: the participants' average monthly attendance, as reported by the program's staff: <emph>low attendance</emph>, 0–1 monthly sessions; <emph>moderate attendance</emph>, 2 monthly sessions; <emph>good attendance</emph>, 3 monthly sessions; and <emph>excellent attendance</emph>, 4–5 monthly sessions.</p> <hd id="AN0186163430-17">Qualitative Assessments</hd> <p>In addition to the quantitative assessments detailed above, qualitative evaluations were conducted to expand our understanding of the findings and enable greater generalisation (Bowen [<reflink idref="bib4" id="ref44">4</reflink>]; Wong [<reflink idref="bib42" id="ref45">42</reflink>]). The qualitative component of this study included in‐depth, open‐ended interviews; these were held at the end of the intervention period, with the participation of the program manager, a coordinator and supervisor, and three instructors. With the interviewees' consent, the interviews were recorded and transcribed.</p> <p>We could not interview the participants in the Nordic walking intervention due to the difficulty of obtaining detailed information from individuals with very low verbal communication skills.</p> <hd id="AN0186163430-18">Statistical Analysis</hd> <p></p> <hd id="AN0186163430-19">Quantitative Analysis</hd> <p>Descriptive statistics were used to analyse the quantitative data, including t‐tests for continuous variables and chi‐squared tests for categorical ones. Differences in enjoyment between <emph>T0</emph> and <emph>T1</emph> were examined using paired <emph>t</emph>‐tests.</p> <p>To examine changes in waist‐to‐hip ratios from <emph>T0</emph> to <emph>T1</emph>, the assumption of normality was checked for all data using normality plots (Altman and Bland [<reflink idref="bib1" id="ref46">1</reflink>]) and the Kolmogorov–Smirnov test (Oztuna et al. [<reflink idref="bib32" id="ref47">32</reflink>]). Next, to examine pre‐to‐post‐intervention changes in the participants' fitness and waist‐to‐hip ratio, parametric (paired <emph>t</emph>‐tests) were used for normally distributed variables, and non‐parametric tests (Wilcoxon signed‐rank tests) were used for non‐normally distributed ones. In addition, effect sizes were calculated based on a single pooled standard deviation (Cohen's <emph>d</emph> = mean ∆/standard deviation average of two means), corrected for dependence between means (Morris and DeShon [<reflink idref="bib30" id="ref48">30</reflink>]); effect size < 0.21 was considered trivial; 0.21–0.50 was considered small; and > 0.51 was considered moderate‐to‐high (Cohen [<reflink idref="bib10" id="ref49">10</reflink>]).</p> <p>Data for waist‐to‐hip ratios are presented graphically using the Box and Whisker plot. The graph's central box represents the values from the lower to the upper quartile (25–75 percentile), with the vertical line extending from the minimum to the maximum values and the middle line representing the median. Outside values are denoted in different symbols. Waist‐to‐hip ratio graphs and statistical analyses were conducted separately for male and female participants.</p> <hd id="AN0186163430-20">Qualitative Analysis</hd> <p>After recording and transcribing the five interviews, two of the authors [removed for masked review] coded and analysed each interview to increase dependability; this was conducted in line with the Thematic analysis approach, which is based on identifying, analysing, and interpreting patterns of meaning ('themes') within qualitative data (Clarke and Braun [<reflink idref="bib9" id="ref50">9</reflink>]). Based on this coding, the researchers identified central categories and themes from the interviews. In turn, these categories and themes enabled conceptualizations and insights.</p> <hd id="AN0186163430-21">Results</hd> <p></p> <hd id="AN0186163430-22">The Participants' Anthropometric Characteristics</hd> <p>No significant differences in demographic characteristics and health status at T0 were observed between the study and non‐complete assessment groups (Table 1).</p> <p>1 TABLE Demographic and health status by group.</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">Variable</th><th align="center">Research group (<italic>n</italic> = 34)</th><th align="center">Non‐complete assessment group (<italic>n</italic> = 16)</th><th align="center">Statistic t or chi‐square (<italic>p</italic>)</th></tr><tr><th align="center">Mean (SD) [range] or <italic>n</italic> (%)</th><th align="center">Mean (SD) [range] or <italic>n</italic> (%)</th></tr></thead><tbody valign="top"><tr><td align="left">Demographic characteristics</td><td align="left">Age, years: mean (SD) [range]</td><td align="center">34.10 (9.24) [22.00–57.00]</td><td align="center">35.53 (10.03) [24.00–58.00]</td><td align="center">0.63 (0.54)</td></tr><tr><td align="left">Gender: n (%)</td><td align="left">Male</td><td align="center">24.00 (70.58)</td><td align="center">11.00 (68.75)</td><td align="center">0.05 (0.82)</td></tr><tr><td align="left">Female</td><td align="center">10.00 (29.41)</td><td align="center">5.00 (31.25)</td></tr><tr><td align="left">Family status: n (%)</td><td align="left">Single</td><td align="center">31.00 (91.17)</td><td align="center">15.00 (93.75)</td><td align="center">1.16 (0.26)</td></tr><tr><td align="left">Married</td><td align="center">3.00 (8.82)</td><td align="center">1.00 (6.25)</td></tr><tr><td align="left">Divorced</td><td align="center">—</td><td align="center">—</td></tr><tr><td align="left">Number of children: mean (SD) [range]</td><td align="center">0.03 (0.23) [0.00–2.00]</td><td align="center">0.06 (0.25) [0.00–1.00]</td><td align="center">−0.41 (0.67)</td></tr><tr><td align="left">Religiousness: n (%)</td><td align="left">Secular/traditional</td><td align="center">26.00 (76.47)</td><td align="center">13.00 (81.25)</td><td align="center">1.66 (0.18)</td></tr><tr><td align="left">Religious</td><td align="center">8.00 (23.52)</td><td align="center">3.00 (18.75)</td></tr><tr><td align="left">Health status</td><td align="left">BMI: mean (SD) [range]</td><td align="center">27.00 (6.24) [15.90–48.88]</td><td align="center">26.46 (6.27) [16.50–48.00]</td><td align="center">−1.28 (0.27)</td></tr></tbody></table> </ephtml> </p> <p>1 Abbreviations: BMI = body‐mass index; SD = standard deviation.</p> <hd id="AN0186163430-23">Program Feasibility</hd> <p>When examining the participants' monthly attendance out of 4–5 possible sessions, the lowest attendance was seen in month 4 (M = 1.42 ± 1.24), while the highest was seen in month 6 (M = 3.08 ± 1.29). The mean monthly attendance for the entire program was M = 2.43 ± 0.62 (60.75%), as seen in Table 2. Regarding the entire six months of program attendance, participants attended between 5 and 27 of the total 27 sessions. Sixteen percent of participants attended 50% of the sessions (13 sessions), 20% attended 75% (20 sessions) and 22% completed all 27 sessions.</p> <p>2 TABLE Mean monthly attendance (n  = 34).</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">Month</th><th align="center">Attendance: M (SD) [range]</th></tr></thead><tbody valign="top"><tr><td align="left">1</td><td align="center">3.00 (1.13) [1–4]</td></tr><tr><td align="left">2</td><td align="center">2.67 (1.56) [0–4]</td></tr><tr><td align="left">3</td><td align="center">2.05 (1.36) [0–4]</td></tr><tr><td align="left">4</td><td align="center">1.42 (1.24) [0–3]</td></tr><tr><td align="left">5</td><td align="center">2.38 (0.92) [1–4]</td></tr><tr><td align="left">6</td><td align="center">3.08 (1.29) [0–4]</td></tr><tr><td align="left">Mean monthly attendance</td><td align="center">2.43 (0.62) [0–4]</td></tr></tbody></table> </ephtml> </p> <p>2 Abbreviations: M = mean; SD = standard deviation.</p> <hd id="AN0186163430-24">Pre‐To‐Post‐Intervention Fitness Measures</hd> <p>The findings indicate improvements from <emph>T0</emph> to <emph>T1</emph> in two fitness measures; (<reflink idref="bib1" id="ref51">1</reflink>) the standing long‐jump test (M = 65.37 ± 46.10 and M = 89.50 ± 44.81, respectively, t = 3.29, <emph>p</emph> = 0.003); and (<reflink idref="bib2" id="ref52">2</reflink>) the sit‐and‐reach test (M = 14.19 ± 9.16 and M = 24.90 ± 13.42, respectively; t = 4.88, <emph>p</emph> < 0.001; Table 3). A moderate‐to‐large effect size was seen in both measures (Cohen's <emph>d</emph> = 0.52 for the standing long‐jump test, and 1.16 for the sit‐and‐reach test; Table 4). However, a decrease was seen in the sit‐up tests from <emph>T0</emph> to <emph>T1</emph> (M = 13.14 ± 6.02 and M = 10.28 ± 6.00, respectively; t = −2.66, <emph>p</emph> = 0.015), yet only with a small effect size (Cohen's <emph>d</emph> = −0.47; Table 4). Additionally, no changes were found for cardiovascular fitness (M = 140.18 ± 79.20 and M = 134.77 ± 47.04, respectively; t = 0.39, <emph>p</emph> = 0.69; Table 3), with a minimal effect size (Cohen's <emph>d</emph> = −0.06; Table 4).</p> <p>3 TABLE Pre‐to‐post‐intervention fitness measures (n  = 34).</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">Fitness component</th><th align="center">Test</th><th align="center"><italic>T0</italic> M (SD)</th><th align="center"><italic>T1</italic> Mean (SD)</th><th align="center"><italic>T</italic>‐test (<italic>p</italic>)</th></tr></thead><tbody valign="top"><tr><td align="left">Cardiovascular fitness</td><td align="center">2‐min walk test</td><td align="center">140.18 (79.20)</td><td align="center">134.77 (47.04)</td><td align="center">0.39 (0.69)</td></tr><tr><td align="left">Lower‐extremity power</td><td align="center">Standing long‐jump</td><td align="center">65.37 (46.10)</td><td align="center">89.50 (44.81)</td><td align="center">3.29 (0.003)</td></tr><tr><td align="left">Lower‐extremity muscle endurance</td><td align="center">30‐s sit‐to‐stand</td><td align="center">18.82 (6.74)</td><td align="center">18.08 (6.78)</td><td align="center">−0.56 (0.570)</td></tr><tr><td align="left">Abdominal‐muscle endurance</td><td align="center">30‐s sit‐ups</td><td align="center">13.14 (6.02)</td><td align="center">10.28 (6.00)</td><td align="center">−2.66 (0.015)</td></tr><tr><td align="left">Flexibility</td><td align="center">Sit‐and‐reach</td><td align="center">14.19 (9.16)</td><td align="center">24.90 (13.42)</td><td align="center">4.88 (< 0.001)</td></tr></tbody></table> </ephtml> </p> <ulist> <item>3 <emph>Note:</emph> The significance value is shown in bold.</item> <item>4 Abbreviation: SD = standard deviation.</item> <item>4 TABLE Effect sizes (n  = 34).</item> </ulist> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">Measures</th><th align="center" /><th align="center">Cohen's <italic>d</italic> effect size*</th><th align="center">95% confidence interval (CI)</th></tr></thead><tbody valign="top"><tr><td align="left">Waist‐hip‐ratio</td><td align="center">Male</td><td align="center">−0.68</td><td align="center">−1.04 to −0.30</td></tr><tr><td align="center">Female</td><td align="center">−0.49</td><td align="center">−0.77 to −0.07</td></tr><tr><td align="left">Fitness</td><td align="center">2‐min walking</td><td align="center">−0.06</td><td align="center">−0.38 to 0.38</td></tr><tr><td align="center">Standing long‐jump</td><td align="center">0.52</td><td align="center">0.18 to 1.06</td></tr><tr><td align="center">30‐s sit‐to‐stand</td><td align="center">−0.10</td><td align="center">−0.50 to 0.30</td></tr><tr><td align="center">30‐s sit‐ups</td><td align="center">−0.47</td><td align="center">−0.90 to −0.12</td></tr><tr><td align="center">Sit‐and‐reach</td><td align="center">1.16</td><td align="center">0.65 to 1.64</td></tr></tbody></table> </ephtml> </p> <p>5 <emph>Note:</emph> *Cohen's <emph>d</emph> is based on a single pooled standard deviation. Cohen's <emph>d</emph> was corrected for dependence between means, using Morris and DeShon's equation; Cohen's <emph>d</emph> calculation: mean ∆/standard deviation average from two means. Dark grey cells = moderate and large differences (Cohen's <emph>d</emph> > 0.51); light grey cells = minor differences (Cohen's <emph>d</emph> = 0.21–0.50); white cells = trivial differences (Cohen's <emph>d</emph> < 0.20).</p> <hd id="AN0186163430-25">Pre‐To‐Post‐Intervention Waist‐To‐Hip Ratios</hd> <p>As explained, waist‐to‐hip ratios were measured as a means for evaluating the participants' risk of metabolic health conditions. The findings show a significant post‐intervention decrease in these ratios in both male and female participants (<emph>p</emph> < 0.001 and <emph>p</emph> = 0.03, respectively). Moreover, a 25% and 50% decrease was seen in male (Figure 2a) and female (Figure 2b) participants, respectively, in the prevalence of increased risk of metabolic complications, with a moderate‐to‐large effect size in the former (Cohen's <emph>d</emph> = −0.68) and a small effect size in the latter (Cohen's <emph>d</emph> = −0.49; Table 4).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/E03/01may25/jar70063-fig-0002.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="jar70063-fig-0002.jpg" title="2 Pre‐to‐post‐intervention waist‐to‐hip ratios. Notes: Horizontal lines represent the cut‐off scores for substantially increased (above‐the‐line) risk of metabolic complications; the central box represents the values from the lower‐to‐upper quartile (25 to 75 percentile); the vertical line extends from the minimum to the maximum value; and the middle line represents the median. Outside values are denoted in different symbols." /> </p> <p></p> <hd id="AN0186163430-27">Pre‐To‐Post‐Intervention Enjoyment</hd> <p>The participants' levels of enjoyment at <emph>T0</emph> and <emph>T1</emph> were M = 17.10 ± 3.01 and M = 16.91 ± 2.68, respectively. No significant differences were seen between the two (t = −0.27, <emph>p</emph> = 0.78), and relatively high levels of positive feelings were reported at both time points.</p> <hd id="AN0186163430-28">Qualitative Results</hd> <p>After coding and analysing the interviews, three main themes emerged: (<reflink idref="bib1" id="ref53">1</reflink>) feelings of satisfaction with changes in physical fitness, (<reflink idref="bib2" id="ref54">2</reflink>) dealing with challenges for feasibility establishment, and (<reflink idref="bib3" id="ref55">3</reflink>) professional guidance for better programme achievement.</p> <p> <emph>Theme 1: Feelings of satisfaction with changes in physical fitness</emph>. All interviewees noted this theme. As expressed by N. (instructor): 'I've seen such change in people during this program, and I am pleased that I played a part in this change'. R. (instructor) expressed similar words: 'It's such a pleasure to see people improve because of the activity. There was one lady who was afraid to walk outside. She would always walk slowly down the stairs. But after just one month of doing the Nordic walking, she became much braver, and two months later, she even walked down the stairs without an escort'. Additionally, A. (an instructor) stated the following: 'It's really encouraging and satisfying to see the improvement among the participants. One man used to walk with his body leaning to the right. Now, after this program, he walks much straighter. There was also a man who couldn't even hold or use the Nordic sticks at first, but today he knows how to use them and can place them firmly on the ground'. Finally, I., the program manager said: 'Looking back, I feel satisfied and proud that we were able to get so many groups of people to walk in parks, improve their mobility, feel more confident, and improve their health, through the simple activity of Nordic walking. I would be delighted if we could continue this program and even expand it to additional centres for people with intellectual disabilities'.</p> <p> <emph>Theme 2: Dealing with challenges for feasibility establishment</emph>. As explained by A: 'Sometimes, especially if it was cold or raining, we had to cancel the outdoor Nordic walking activity and find an alternative indoor one'. Similarly, R said: 'Not all the participants always wanted to go on the Nordic walking activity. There was often at least one person who wanted to stay in the centre and do something else. If there wasn't someone who could stay with them indoors, I had to change the plans for everyone else. So, I always tried to recruit people to help me. And even when we were already out walking in the park, I would need additional help, because not everyone walks at the same pace, and different participants need different types of assistance'.</p> <p> <emph>Theme 3: Professional guidance for better program achievement</emph>. As explained by I., 'We placed much emphasis on the instructors' training because we knew that the more professional they are, the better they will be able to guide the participants throughout the program'. This theme was also mentioned by A., who said: 'Whenever I had a question about the program, or about a certain exercise, or about how to increase the difficulty levels, I would always call [the manager] to consult with him because I know how important is to be professional, for better fitness improvement, and the general program achievements'. Finally, S. (the program coordinator) said: 'I visit each centre once a month to supervise the instructors. We review the work plans, see which goals have been achieved, what needs to be changed or improved, and we also set new goals for the next month'.</p> <hd id="AN0186163430-29">Discussion</hd> <p>The aim of this study was to evaluate the feasibility of a six‐month Nordic walking intervention and assess its effect on physical fitness and emotional status among adults with intellectual and developmental disabilities. The primary findings suggest that Nordic walking activities are feasible among adults for this population, demonstrated by a relatively high participation rate and improvement in lower‐body strength, flexibility, and waist‐to‐hip ratios, which may reduce their risk of chronic health conditions.</p> <p>Previous studies have shown similar benefits from physical activity interventions for individuals with intellectual and developmental disabilities. They reported significant improvements in muscle endurance, self‐efficacy and physical activity levels after a 12‐week aerobic and strength program. In a more extended intervention, Calders et al. ([<reflink idref="bib5" id="ref56">5</reflink>]) found that a 20‐week combination of aerobic and strength training improved cholesterol levels, aerobic capacity, muscle strength and systolic blood pressure compared to participants in the control groups. The authors, therefore, suggested that the combination of endurance and strength training is more effective than endurance training alone. While Nordic walking is primarily considered an endurance activity, participants in the current study were encouraged to apply force with each pole plant on the ground, pushing hard to do so, potentially increasing muscle exertion beyond regular walking (Tschentscher et al. [<reflink idref="bib41" id="ref57">41</reflink>]).</p> <p>This may explain the observed improvements in lower‐body strength following the six‐month Nordic walking intervention. A strong lower body is essential in daily living and helps postpone age‐related muscle deterioration (Carmeli and Imam [<reflink idref="bib7" id="ref58">7</reflink>]).</p> <p>However, unlike the studies mentioned above, cardiovascular fitness did not change in the current study, and abdominal muscle endurance decreased following the intervention. This may be due to the lower frequency of sessions (once per week) compared to other studies with more frequent training sessions (i.e., twice a week at Calders et al. [<reflink idref="bib5" id="ref59">5</reflink>]). These findings suggest that while once‐weekly NW sessions may be sufficient for enhancing muscular strength, they may not adequately improve muscular or cardiovascular endurance.</p> <p>While many physical activity interventions for individuals with intellectual and developmental disabilities are based on indoor activities (Calders et al. [<reflink idref="bib5" id="ref60">5</reflink>]; Wu et al. [<reflink idref="bib44" id="ref61">44</reflink>]), A unique aspect of this study was the outdoor setting, which likely contributed to the high participation and enjoyment rates. As recommended by Lahart et al. ([<reflink idref="bib22" id="ref62">22</reflink>]), engaging participants with natural surroundings and incorporating recreational elements has been shown to enhance physical activity engagement in adults with intellectual and developmental disabilities (Barak and Dunsky [<reflink idref="bib2" id="ref63">2</reflink>]). Furthermore, instructors emphasised proper breathing techniques during NW, which is particularly relevant given the prevalence of respiratory disorders in this population (Truesdale et al. [<reflink idref="bib40" id="ref64">40</reflink>]). The combination of guided breathing and physical exertion likely contributed to reduced waist‐to‐hip ratios, indicating improved metabolic health.</p> <p>It is possible that the increased muscular strength and flexibility following the Nordic walking activities led to the participants' use of a more extensive range of motion and muscle activation during their daily living activities, consequently increasing their metabolic circulation and leading to caloric deficits and improved waist‐to‐hip ratios (Carmeli and Imam [<reflink idref="bib7" id="ref65">7</reflink>]).</p> <p>Despite these positive outcomes, the decrease in abdominal muscle endurance and lack of improvement in aerobic fitness were unexpected, as Nordic walking is considered an aerobic activity and, as such—should improve endurance (Tschentscher et al. [<reflink idref="bib41" id="ref66">41</reflink>]). It is possible that the once‐weekly frequency was insufficient for improving these parameters, as higher‐frequency programmes have shown better results (Wu et al. [<reflink idref="bib44" id="ref67">44</reflink>]). However, increasing session frequency can be challenging for adults with intellectual and developmental disabilities due to motivational, logistical and financial barriers (Bartlo and Klein [<reflink idref="bib3" id="ref68">3</reflink>]; Dixon‐Ibarra et al. [<reflink idref="bib12" id="ref69">12</reflink>]; Jacob et al. [<reflink idref="bib20" id="ref70">20</reflink>]). Future research should explore the comparative effects of different training frequencies to optimise outcomes.</p> <p>The relatively high adherence rate found in the current study (60.75%) suggests that Nordic walking is feasible and enjoyable for adults with intellectual and developmental disabilities. Previous studies highlight the importance of tailored support and strategies to enhance physical activity participation (Carbo‐Carrete et al. [<reflink idref="bib6" id="ref71">6</reflink>]; Martinez‐Millana et al. [<reflink idref="bib29" id="ref72">29</reflink>]; Sundblom et al. [<reflink idref="bib37" id="ref73">37</reflink>]). While participants in this study were part of a 'captive population' attending a designated club, adherence rates remain notable given that many adults with intellectual and developmental disabilities, even in supportive environments, do not regularly engage in physical activity (Dixon‐Ibarra et al. [<reflink idref="bib12" id="ref74">12</reflink>]; Dunsky and Barak [<reflink idref="bib13" id="ref75">13</reflink>]; Emerson [<reflink idref="bib15" id="ref76">15</reflink>]; Hsieh et al. [<reflink idref="bib18" id="ref77">18</reflink>]). Thus, it is essential to implement creative means for encouraging adults with intellectual and developmental disabilities to engage in such activities, especially as part of their regular routines (Jacob et al. [<reflink idref="bib20" id="ref78">20</reflink>]).</p> <p>The qualitative section of this study suggests that the instructors' involvement played a crucial role in the program's success. Their ability to motivate participants, adjust sessions to individual needs, and address challenges contributed significantly to adherence and performance improvements. The qualitative analysis showed that the instructors were satisfied with some participants' improved fitness, skills, and performance. Thus, ensuring instructors are well trained and supported to deal with challenges quickly and effectively, as well as gradually increasing the program intensity in a professional way, is essential for the success of such interventions.</p> <p>A key strength of this study is demonstrating Nordic walking as a feasible, enjoyable, and health‐beneficial activity for adults with intellectual and developmental disabilities. However, there are several limitations to this study. First, abdominal endurance decreased with no improvement in aerobic endurance following the intervention, contrary to our expectations. Thus, future studies should seek additional ways to improve endurance during the intervention. Second, 16 participants did not appear for the post‐intervention time point (the Non‐Complete Assessment Group). Thus, different results could have been obtained if they had been sampled. Third, intensity measurements were not used; therefore, we could not provide insights into participant effort. Lastly, the sample's gender in the current study was imbalanced, which may affect the generalisability of findings. Considering these limitations, it is recommended that a larger group of gender‐balanced participants be recruited to deal with similar cases in future studies.</p> <hd id="AN0186163430-30">Conclusions</hd> <p>The findings of this study suggest that a six‐month Nordic walking intervention, comprised of once‐weekly sessions, has a positive effect on lower‐body strength, flexibility, and chronic health risks in individuals with intellectual and developmental disabilities. These benefits likely stem from the unique characteristics of this physical activity, which is based on enjoyable and motivating outdoor walking with Nordic poles. Moreover, Nordic walking improves skills critical to daily functioning, especially those requiring gait and balance. Policymakers, organisations, healthcare providers, and caregivers should, therefore, consider developing and implementing Nordic walking intervention programmes for the adult population in general and individuals with intellectual and developmental disabilities in particular.</p> <hd id="AN0186163430-31">Ethics Statement</hd> <p>The study was approved by the Ethics Committee of the Levinsky‐Wingate Academic College, Wingate Campus (former name: the Academic College at Wingate) (no. 00932016).</p> <hd id="AN0186163430-32">Consent</hd> <p>Both the participants and their legal guardians signed a written informed consent form.</p> <hd id="AN0186163430-33">Conflicts of Interest</hd> <p>The authors declare no conflicts of interest.</p> <hd id="AN0186163430-34">Data Availability Statement</hd> <p>The data that support the findings of this study are available from the corresponding author upon reasonable request.</p> <ref id="AN0186163430-35"> <title> Footnotes </title> <blist> <bibl id="bib1" idref="ref32" type="bt">1</bibl> <bibtext> Funding: This work was supported by the National Insurance Institute of Israel; Fund for Demonstration Projects, Grant/Award Number: 13568.</bibtext> </blist> </ref> <ref id="AN0186163430-36"> <title> References </title> <blist> <bibtext> Altman, D. G., and J. M. Bland. 1995. " Statistics Notes: The Normal Distribution." British Medical Journal 310 : 298. https://doi.org/10.1136/bmj.310.6975.298.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref33" type="bt">2</bibl> <bibtext> Barak, S., and A. Dunsky. 2023. " Long‐Term Outdoor Recreation Program for Adults With Intellectual Disabilities: Feasibility and Effects." Journal of Applied Research in Intellectual Disabilities 36, no. 5 : 1113 – 1123. https://doi.org/10.1111/jar.13130.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref14" type="bt">3</bibl> <bibtext> Bartlo, P., and P. J. Klein. 2011. " Physical Activity Benefits and Needs in Adults With Intellectual Disabilities: Systematic Review of the Literature." American Journal on Intellectual and Developmental Disabilities 116, no. 3 : 220 – 232. https://doi.org/10.1352/1944‐7558‐116.3.220.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref35" type="bt">4</bibl> <bibtext> Bowen, G. A. 2006. " Grounded Theory and Sensitizing Concepts." International Journal of Qualitative Methods 5, no. 3 : 12 – 23. https://doi.org/10.1177/1609406906005003.</bibtext> </blist> <blist> <bibl id="bib5" idref="ref36" type="bt">5</bibl> <bibtext> Calders, P., S. Elmahgoub, T. R. de Mettelinge, et al. 2011. " Effect of Combined Exercise Training on Physical and Metabolic Fitness in Adults With Intellectual Disability: A Controlled Trial." Clinical Rehabilitation 25, no. 12 : 1097 – 1108.</bibtext> </blist> <blist> <bibl id="bib6" idref="ref71" type="bt">6</bibl> <bibtext> Carbo‐Carrete, M., J. Guàrdia‐Olmos, C. Giné, and R. L. Schalock. 2016. " A Structural Equation Model of the Relationship Between Physical Activity and Quality of Life." International Journal of Clinical and Health Psychology 16, no. 2 : 147 – 156.</bibtext> </blist> <blist> <bibl id="bib7" idref="ref2" type="bt">7</bibl> <bibtext> Carmeli, E., and B. Imam. 2014. " Health Promotion and Disease Prevention Strategies in Older Adults With Intellectual and Developmental Disabilities." Frontiers in Public Health 2 : 31. https://doi.org/10.3389/fpubh.2014.00031.</bibtext> </blist> <blist> <bibl id="bib8" idref="ref39" type="bt">8</bibl> <bibtext> Centers for Disease Control and Prevention. 2017. 30‐Second Chair Stand (p. 1). https://<ulink href="http://www.cdc.gov/steadi/pdf/STEADI‐Assessment‐30Sec‐508.pdf">www.cdc.gov/steadi/pdf/STEADI‐Assessment‐30Sec‐508.pdf</ulink>.</bibtext> </blist> <blist> <bibl id="bib9" idref="ref50" type="bt">9</bibl> <bibtext> Clarke, V., and V. Braun. 2017. " Thematic Analysis." Journal of Positive Psychology 12, no. 3 : 297 – 298.</bibtext> </blist> <blist> <bibtext> Cohen, J. 1977. Statistical Power Analysis for Behavioral Sciences. Revised ed. Academic Press.</bibtext> </blist> <blist> <bibtext> Cooper, C. L., ed. 2015. Wiley Encyclopedia of Management. John Wiley & Sons, Ltd. https://doi.org/10.1002/9781118785317.</bibtext> </blist> <blist> <bibtext> Dixon‐Ibarra, A., S. Driver, K. Vanderbom, and K. Humphries. 2017. " Understanding Physical Activity in the Group Home Setting: A Qualitative Inquiry." Disability and Rehabilitation 39, no. 7 : 653 – 662. https://doi.org/10.3109/09638288.2016.1160294.</bibtext> </blist> <blist> <bibtext> Dunsky, A., and S. Barak. 2024. " Health Promotion With Long‐Term Physical Activity Program for Adults With Autism Spectrum Disorder." Healthcare 12, no. 2 : 247. https://doi.org/10.3390/healthcare12020247.</bibtext> </blist> <blist> <bibtext> Dunstan, D. W., B. Howard, G. N. Healy, and N. Owen. 2012. " Too Much Sitting: A Health Hazard." Diabetes Research and Clinical Practice 97, no. 3 : 368 – 376.</bibtext> </blist> <blist> <bibtext> Emerson, E. 2005. " Underweight, Obesity and Exercise Among Adults With Intellectual Disabilities in Supported Accommodation in Northern England." Journal of Intellectual Disability Research 49, no. 2 : 134 – 143. https://doi.org/10.1111/j.1365‐2788.2004.00617.x.</bibtext> </blist> <blist> <bibtext> Faul, F., E. Erdfelder, A.‐G. Lang, and A. Buchner. 2007. " G*Power 3: A Flexible Statistical Power Analysis Program for the Social, Behavioral, and Biomedical Sciences." Behavior Research Methods 39, no. 2 : 175 – 191. https://doi.org/10.3758/BF03193146.</bibtext> </blist> <blist> <bibtext> Frey, G. C., V. A. Temple, and H. I. Stanish. 2017. " Interventions to Promote Physical Activity for Youth With Intellectual Disabilities." Salud Pública de México 59, no. 4 : 437 – 445. https://doi.org/10.21149/8203.</bibtext> </blist> <blist> <bibtext> Hsieh, K., T. Heller, J. Bershadsky, and S. Taub. 2015. " Impact of Adulthood Stage and Social‐Environmental Context on Body Mass Index and Physical Activity of Individuals With Intellectual Disability." Intellectual and Developmental Disabilities 53, no. 2 : 100 – 113. https://doi.org/10.1352/1934‐9556‐53.2.100.</bibtext> </blist> <blist> <bibtext> Hutzler, Y., M. Oz, and S. Barak. 2013. " Goal Perspectives and Sport Participation Motivation of Special Olympians and Typically Developing Athletes." Research in Developmental Disabilities 34, no. 7 : 2149 – 2160. https://doi.org/10.1016/j.ridd.2013.03.019.</bibtext> </blist> <blist> <bibtext> Jacob, U. S., J. Pillay, E. Johnson, O. Omoya, and A. P. Adedokun. 2023. " A Systematic Review of Physical Activity: Benefits and Needs for Maintenance of Quality of Life Among Adults With Intellectual Disability." Frontiers in Sports and Active Living 5 : 1184946. https://doi.org/10.3389/fspor.2023.1184946.</bibtext> </blist> <blist> <bibtext> Johnson, C. C. 2009. " The Benefits of Physical Activity for Youth With Developmental Disabilities: A Systematic Review." American Journal of Health Promotion 23, no. 3 : 157 – 167. https://doi.org/10.4278/ajhp.070930103.</bibtext> </blist> <blist> <bibtext> Lahart, I., P. Darcy, C. Gidlow, and G. Calogiuri. 2019. " The Effects of Green Exercise on Physical and Mental Wellbeing: A Systematic Review." International Journal of Environmental Research and Public Health 16, no. 8 : 1352. https://doi.org/10.3390/ijerph16081352.</bibtext> </blist> <blist> <bibtext> Liguori, G., and ACSM. 2020. ACSM's Guidelines for Exercise Testing and Prescription. Lippincott Williams & Wilkins.</bibtext> </blist> <blist> <bibtext> Lin, J. D., C. L. Wu, P. Y. Lin, L. P. Lin, and C. M. Chu. 2011. " Early Onset Ageing and Service Preparation in People With Intellectual Disabilities: Institutional Managers' Perspective." Research in Developmental Disabilities 32, no. 1 : 188 – 193. https://doi.org/10.1016/j.ridd.2010.09.018.</bibtext> </blist> <blist> <bibtext> Lotan, M. 2007. " Quality Physical Intervention Activity for Persons With Down Syndrome." Scientific World Journal 7 : 7 – 19. https://doi.org/10.1100/tsw.2007.20.</bibtext> </blist> <blist> <bibtext> Lotan, M., E. Isakov, S. Kessel, and J. Merrick. 2004. " Physical Fitness and Functional Ability of Children With Intellectual Disability: Effects of a Short‐Term Daily Treadmill Intervention." Scientific World Journal 4 : 449 – 457. https://doi.org/10.1100/tsw.2004.97.</bibtext> </blist> <blist> <bibtext> Lotan, M., S. Yalon‐Chamovitz, and P. L. T. Weiss. 2009. " Improving Physical Fitness of Individuals With Intellectual and Developmental Disability Through a Virtual Reality Intervention Program." Research in Developmental Disabilities 30, no. 2 : 229 – 239. https://doi.org/10.1016/j.ridd.2008.03.005.</bibtext> </blist> <blist> <bibtext> Mahy, J., N. Shields, N. F. Taylor, and K. J. Dodd. 2010. " Identifying Facilitators and Barriers to Physical Activity for Adults With Down Syndrome." Journal of Intellectual Disability Research 54 : 795 – 805. https://doi.org/10.1111/j.1365‐2788.2010.01308.x.</bibtext> </blist> <blist> <bibtext> Martinez‐Millana, A., H. Michalsen, V. Berg, et al. 2022. " Motivating Physical Activity for Individuals With Intellectual Disability Through Indoor Bike Cycling and Exergaming." International Journal of Environmental Research and Public Health 19, no. 5 : 2914. https://doi.org/10.3390/ijerph19052914.</bibtext> </blist> <blist> <bibtext> Morris, S. B., and R. P. DeShon. 2002. " Combining Effect Size Estimates in Meta‐Analysis With Repeated Measures and Independent‐Groups Designs." Psychological Methods 7, no. 1 : 105 – 125. https://doi.org/10.1037/1082‐989X.7.1.105.</bibtext> </blist> <blist> <bibtext> Obrusnikova, I., C. J. Firkin, and W. B. Farquhar. 2022. " A Systematic Review and Meta‐Analysis of the Effects of Aerobic Exercise Interventions on Cardiorespiratory Fitness in Adults With Intellectual Disability." Disability and Health Journal 15, no. 1 : 101185.</bibtext> </blist> <blist> <bibtext> Oztuna, D., A. H. Elhan, and E. Tuccar. 2006. " Investigation of Four Different Normality Tests in Terms of Type 1 Error Rate and Power Under Different Distributions." Turkish Journal of Medical Sciences 36, no. 3 : 171 – 176.</bibtext> </blist> <blist> <bibtext> Selman, J. P., A. A. de Camargo, J. Santos, F. C. Lanza, and S. Dal Corso. 2014. " Reference Equation for the 2‐Minute Walk Test in Adults and the Elderly." Respiratory Care 59, no. 4 : 525 – 530.</bibtext> </blist> <blist> <bibtext> Skowroński, W., M. Horvat, J. Nocera, G. Roswal, and R. Croce. 2009. " Eurofit Special: European Fitness Battery Score Variation Among Individuals With Intellectual Disabilities." Adapted Physical Activity Quarterly 26, no. 1 : 54 – 67.</bibtext> </blist> <blist> <bibtext> St. John, L., G. Borschneck, and J. Cairney. 2020. " A Systematic Review and Meta‐Analysis Examining the Effect of Exercise on Individuals With Intellectual Disability." American Journal on Intellectual and Developmental Disabilities 125, no. 4 : 274 – 286. https://doi.org/10.1352/1944‐7558‐125.4.274.</bibtext> </blist> <blist> <bibtext> State of Israel—Ministry of Special Education. 2016. Working Principles in Teaching Students With Developmental and Intellectual Disability, 1 – 28. State of Israel – Ministry of Special Education. https://meyda.education.gov.il/files/special/pedagogy/moshe1.pdf.</bibtext> </blist> <blist> <bibtext> Sundblom, E., H. Bergström, and L. S. Ellinder. 2015. " Understanding the Implementation Process of a Multi‐Component Health Promotion Intervention for Adults With Intellectual Disabilities in Sweden." Journal of Applied Research in Intellectual Disabilities 28, no. 4 : 296 – 306.</bibtext> </blist> <blist> <bibtext> Temple, V. A., G. C. Frey, and H. I. Stanish. 2006. " Physical Activity of Adults With Mental Retardation: Review and Research Needs." American Journal of Health Promotion 21, no. 1 : 2 – 12. https://doi.org/10.1177/089011710602100103.</bibtext> </blist> <blist> <bibtext> Tremblay, M. S., R. C. Colley, T. J. Saunders, G. N. Healy, and N. Owen. 2010. " Physiological and Health Implications of a Sedentary Lifestyle." Applied Physiology, Nutrition, and Metabolism 35, no. 6 : 725 – 740. https://doi.org/10.1139/H10‐079.</bibtext> </blist> <blist> <bibtext> Truesdale, M., C. Melville, F. Barlow, et al. 2021. " Respiratory‐Associated Deaths in People With Intellectual Disabilities: A Systematic Review and Meta‐Analysis." BMJ Open 11, no. 7 : e043658. https://doi.org/10.1136/bmjopen‐2020‐043658.</bibtext> </blist> <blist> <bibtext> Tschentscher, M., D. Niederseer, and J. Niebauer. 2013. " Health Benefits of Nordic Walking: A Systematic Review." American Journal of Preventive Medicine 44, no. 1 : 76 – 84. https://doi.org/10.1016/j.amepre.2012.09.043.</bibtext> </blist> <blist> <bibtext> Wong, L. 2008. " Data Analysis in Qualitative Research: A Brief Guide Using Nvivo." Malaysian Family Physician 3, no. 1 : 14 – 20.</bibtext> </blist> <blist> <bibtext> World Health Organization. 2020. WHO Guidelines on Physical Activity and Sedentary Behaviour. World Health Organization.</bibtext> </blist> <blist> <bibtext> Wu, C. L., J. D. Lin, J. Hu, et al. 2010. " The Effectiveness of Healthy Physical Fitness Programs on People With Intellectual Disabilities Living in a Disability Institution: Six‐Month Short‐Term Effect." Research in Developmental Disabilities 31, no. 3 : 713 – 717.</bibtext> </blist> <blist> <bibtext> Yanardag, M., H. Arikan, I. Yilmaz, and F. Konukman. 2013. " Physical Fitness Levels of Young Adults With and Without Intellectual Disability." Kinesiology 45, no. 2 : 233 – 240.</bibtext> </blist> </ref> <aug> <p>By Ayelet Dunsky and Sharon Barak</p> <p>Reported by Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib24" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib40" firstref="ref3"></nolink> <nolink nlid="nl3" bibid="bib43" firstref="ref4"></nolink> <nolink nlid="nl4" bibid="bib15" firstref="ref5"></nolink> <nolink nlid="nl5" bibid="bib18" firstref="ref6"></nolink> <nolink nlid="nl6" bibid="bib23" firstref="ref7"></nolink> <nolink nlid="nl7" bibid="bib14" firstref="ref8"></nolink> <nolink nlid="nl8" bibid="bib38" firstref="ref9"></nolink> <nolink nlid="nl9" bibid="bib39" firstref="ref10"></nolink> <nolink nlid="nl10" bibid="bib20" firstref="ref11"></nolink> <nolink nlid="nl11" bibid="bib27" firstref="ref12"></nolink> <nolink nlid="nl12" bibid="bib31" firstref="ref13"></nolink> <nolink nlid="nl13" bibid="bib21" firstref="ref15"></nolink> <nolink nlid="nl14" bibid="bib26" firstref="ref16"></nolink> <nolink nlid="nl15" bibid="bib29" firstref="ref18"></nolink> <nolink nlid="nl16" bibid="bib25" firstref="ref19"></nolink> <nolink nlid="nl17" bibid="bib12" firstref="ref20"></nolink> <nolink nlid="nl18" bibid="bib28" firstref="ref24"></nolink> <nolink nlid="nl19" bibid="bib41" firstref="ref25"></nolink> <nolink nlid="nl20" bibid="bib17" firstref="ref26"></nolink> <nolink nlid="nl21" bibid="bib35" firstref="ref27"></nolink> <nolink nlid="nl22" bibid="bib36" firstref="ref28"></nolink> <nolink nlid="nl23" bibid="bib19" firstref="ref29"></nolink> <nolink nlid="nl24" bibid="bib16" firstref="ref30"></nolink> <nolink nlid="nl25" bibid="bib22" firstref="ref31"></nolink> <nolink nlid="nl26" bibid="bib33" firstref="ref37"></nolink> <nolink nlid="nl27" bibid="bib34" firstref="ref38"></nolink> <nolink nlid="nl28" bibid="bib45" firstref="ref40"></nolink> <nolink nlid="nl29" bibid="bib11" firstref="ref41"></nolink> <nolink nlid="nl30" bibid="bib42" firstref="ref45"></nolink> <nolink nlid="nl31" bibid="bib32" firstref="ref47"></nolink> <nolink nlid="nl32" bibid="bib30" firstref="ref48"></nolink> <nolink nlid="nl33" bibid="bib10" firstref="ref49"></nolink> <nolink nlid="nl34" bibid="bib44" firstref="ref61"></nolink> <nolink nlid="nl35" bibid="bib37" firstref="ref73"></nolink> <nolink nlid="nl36" bibid="bib13" firstref="ref75"></nolink>
Header DbId: eric
DbLabel: ERIC
An: EJ1474917
AccessLevel: 3
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: A Six-Month Nordic Walking Program for Adults with Intellectual and Developmental Disabilities: Feasibility and Effect
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Ayelet+Dunsky%22">Ayelet Dunsky</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-9228-7007">0000-0002-9228-7007</externalLink>)<br /><searchLink fieldCode="AR" term="%22Sharon+Barak%22">Sharon Barak</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-0714-4798">0000-0003-0714-4798</externalLink>)
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Applied+Research+in+Intellectual+Disabilities%22"><i>Journal of Applied Research in Intellectual Disabilities</i></searchLink>. 2025 38(3).
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 10
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Physical+Activities%22">Physical Activities</searchLink><br /><searchLink fieldCode="DE" term="%22Intellectual+Disability%22">Intellectual Disability</searchLink><br /><searchLink fieldCode="DE" term="%22Adults%22">Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Physical+Activity+Level%22">Physical Activity Level</searchLink><br /><searchLink fieldCode="DE" term="%22At+Risk+Persons%22">At Risk Persons</searchLink><br /><searchLink fieldCode="DE" term="%22Chronic+Illness%22">Chronic Illness</searchLink><br /><searchLink fieldCode="DE" term="%22Developmental+Disabilities%22">Developmental Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Psychomotor+Skills%22">Psychomotor Skills</searchLink><br /><searchLink fieldCode="DE" term="%22Physical+Mobility%22">Physical Mobility</searchLink><br /><searchLink fieldCode="DE" term="%22Physiology%22">Physiology</searchLink><br /><searchLink fieldCode="DE" term="%22Environment%22">Environment</searchLink><br /><searchLink fieldCode="DE" term="%22Emotional+Development%22">Emotional Development</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Muscular+Strength%22">Muscular Strength</searchLink><br /><searchLink fieldCode="DE" term="%22Outcomes+of+Treatment%22">Outcomes of Treatment</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Promotion%22">Health Promotion</searchLink><br /><searchLink fieldCode="DE" term="%22Physical+Health%22">Physical Health</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1111/jar.70063
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1360-2322<br />1468-3148
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Individuals with intellectual and developmental disabilities tend to engage in low levels of physical activity, which puts them at risk for chronic health conditions, poor balance and gait difficulties. Nordic walking could improve gait, balance, strength, endurance and respiratory function while enjoying nature. Method: Thirty-four adults with intellectual and developmental disabilities were assessed for physical performance and emotional status before and after participating in a six-month intervention comprised of weekly Nordic walking sessions. Five staff members were also interviewed about the programme. Results: Nordic walking was found to be feasible, with an average monthly attendance of 60.75%. Following the intervention, significant improvements were seen in lower-extremity strength, flexibility and waist-to-hip ratios. Conclusions: Nordic walking motivates participants to engage in physical activity, strengthens muscles, and increases flexibility. Thus, people who work with adults with intellectual and developmental disabilities may consider including Nordic walking in their health enhancement and maintenance programmes.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2025
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1474917
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1474917
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1111/jar.70063
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 10
    Subjects:
      – SubjectFull: Physical Activities
        Type: general
      – SubjectFull: Intellectual Disability
        Type: general
      – SubjectFull: Adults
        Type: general
      – SubjectFull: Physical Activity Level
        Type: general
      – SubjectFull: At Risk Persons
        Type: general
      – SubjectFull: Chronic Illness
        Type: general
      – SubjectFull: Developmental Disabilities
        Type: general
      – SubjectFull: Psychomotor Skills
        Type: general
      – SubjectFull: Physical Mobility
        Type: general
      – SubjectFull: Physiology
        Type: general
      – SubjectFull: Environment
        Type: general
      – SubjectFull: Emotional Development
        Type: general
      – SubjectFull: Intervention
        Type: general
      – SubjectFull: Muscular Strength
        Type: general
      – SubjectFull: Outcomes of Treatment
        Type: general
      – SubjectFull: Health Promotion
        Type: general
      – SubjectFull: Physical Health
        Type: general
    Titles:
      – TitleFull: A Six-Month Nordic Walking Program for Adults with Intellectual and Developmental Disabilities: Feasibility and Effect
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Ayelet Dunsky
      – PersonEntity:
          Name:
            NameFull: Sharon Barak
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 05
              Type: published
              Y: 2025
          Identifiers:
            – Type: issn-print
              Value: 1360-2322
            – Type: issn-electronic
              Value: 1468-3148
          Numbering:
            – Type: volume
              Value: 38
            – Type: issue
              Value: 3
          Titles:
            – TitleFull: Journal of Applied Research in Intellectual Disabilities
              Type: main
ResultId 1