Abstract:

Objective To construct a research framework on the health and functional outcomes of children with intellectual disability participating in physical activities using World Health Organization Family of International Classifications (WHO-FICs), and systematically analyze the main health and functional impairment manifestations, interventions of physical activity, and health and functional outcomes of children and adolescents with intellectual disability.
Methods International Classification of Diseases, Eleventh Revision (ICD-11), and International Classification of Functioning, Disability and Health (ICF) were used to systematically analyze physical activity intervention programs for children and adolescents with intellectual disability, and health and functional outcomes, to develop a structure of health and functional status, physical activity intervention programs, and health and functional outcomes. Systematic reviews about physical activity, and health and functional outcomes of children and adolescents with intellectual disability were retrieved from Scopus, PubMed, Embase, Web of Science, CNKI, VIP and Wanfang Data, from establishment to August 18th, 2022, and a systematic review of systematic reviews was conducted.
Results Eight systematic reviews were finally included, from five countries, included a total of 190 randomized controlled trials and 7 011 participants, in the fields of intellectual disability, child neurology, rehabilitation sciences, disability and health, adaptive physical education, and special education, which mainly published from 2018 to 2022. The main common health conditions were Down syndrome, autism spectrum disorder, fragile X syndrome, Prader-Willi syndrome, intellectual disability and cognitive impairment. Physical activity interventions mainly involved physical fitness, skills, and activities, with the frequency of one to five times a week, moderate to high intensity, and duration of one week to 1.5 years. The health outcomes mainly involved in three aspects: intellectual function and adaptive behavior, physical activity, and psycho-behavioral health and social adaptation, overall quality of life and well-being.
Conclusion A conceptual framework for the health outcomes of physical activity and exercise rehabilitation for children and adolescents with intellectual disability has been constructed based on WHO-FICs. The main functioning of children and adolescents with intellectual disability are manifested at three levels: intellectual functioning and adaptive behavior, activity and participation, and mental health, quality of life and well-being, where limitations of intellectual functioning and adaptive behavior involve conceptual, social and practical skills; and low physical activity participation, sedentary and obesity, low mobility, and failure to develop basic motor skills and physical fitness at the level of activity and participation; for the quality of life and well-being, limitations involve mood and emotion, self-esteem, general self-concept, well-being, friendships, relationships with others or social maturity, and quality of life and well-being. Intervention programs of physical activity can be divided into physical fitness, skills and sports. The primary health and functional outcomes are synthesized in three main domains, namely intellectual functioning and adaptive behavior, activity and participation, and mental health, quality of life and well-being. In the intellectual functioning and adaptive behavior domain, the primary health outcomes involved cognitive functioning (executive functioning, cognitive plasticity, working memory, etc.) and psychological functioning (emotional self-control, self-worth, and self-esteem). In the activity and participation domain, physical activity contributes to the development of physical fitness (muscle strength and endurance, speed, agility) and motor skills (basic motor skills, balance, core stability), to increase the participation in physical activity, promote better adaptation and empowerment (socialization, prosocial behavior), and to achieve the health goals (reduction of disease risk, anxiety and depression, and management of obesity). In the domain of psycho-behavioral health and social adaptation, quality of life, and well-being, physical activity and exercise rehabilitation can improve overall quality of life and well-being.

Key words: intellectual disability, physical activity, exercise rehabilitation, World Health Organization Family of International Classifications, systematic review