JMIR Publications

ABSTRACT

Background:

Physical activity (PA), sedentary behaviour (SB), and sleep play a key role in the health and development of young people (Carson et al., 2016; Chaput et al., 2016; Poitras et al., 2016). This has led to the development of guidelines on PA, SB and sleep for children and young people aged 5-17 years (Health, 2017; Tremblay et al., 2016). Young people aged 12-17 years should engage in at least 60 minutes or more of moderate-to-vigorous physical activity (MVPA) per day mainly involving aerobic activity and several hours of a variety of light movement activities. Whilst the WHO guidelines only recommend limiting sitting time (specifically recreational screen time), guidelines of some countries—e.g., Canada, Australia, and New Zealand—specify limiting recreational screen time to no more than two-hours per day and breaking up long periods of sitting as often as possible (Carson et al., 2017; Chaput et al., 2014; Tremblay et al., 2016). Young people are also recommended to achieve 9-11 hours of uninterrupted sleep per night (for 12-13-year-olds) or 8-10 hours of uninterrupted sleep (for 14-17-year-olds) and consistent bed and wake times (Bruni et al., 2025). A growing body of evidence shows that PA, SB, and sleep interact with one another within any 24-hour period (Chaput et al., 2020). Therefore, it is important to acknowledge that each of the three elements (i.e., PA, SB and sleep) have the potential to impact on one another. For example, poor sleep that is unaddressed will make PA unlikely and is likely to raise levels of SB (Tremblay et al., 2016). Several studies have indicated that young people who meet at least two of the three 24-hr MBs guidelines had better cognitive function, improved mental health and lower all-cause mortality when compared with those who were not able to meet any of the 24-hr MBs (Hao et al., 2024; Huang et al., 2024; Zhang et al., 2023). In studies that have involved children and young people with a variety of conditions (i.e., Autistic Spectrum Disorder (ASD), Attention-Deficit-Hyperactivity-Disorder (ADHD), disabilities etc.), similar findings have been reported, identifying low prevalence in adhering to the 24-hr MBs. For example, Totsika et al. (2022) identified that people with intellectual disabilities tended to spend large volumes of time in SB and tended to not engage in sufficient PA (Totsika et al., 2022). Li and colleagues (2022) in conducting a seven country observational study found that only 2% of children and young people with ASD adhered to all 24-hr MBs guidelines with 22% meeting none of the guidelines (Li et al., 2022). Similar to previous findings, a recent systematic review and meta-analysis conducted by Huang et al. (2024) identified that when comparing participants with disabilities who meet at least two of the three 24-hr MB guidelines, individuals with disabilities who do not meet any guidelines had higher anxiety, depression and other mental health symptoms (Huang et al., 2024). In addition, other studies have shown that individuals with ASD who meet all three 24-hr MBs have a significantly higher quality of life than those not meeting any (Kong et al., 2023; Li et al., 2022). However, there is a specific challenge in determining population definitions. Current literature uses intermittent nomenclature including intellectual disabilities, learning disabilities, learning difficulties, neurodevelopmental disorders, physical disabilities, and cognitive impairments. Each of the characteristics of different populations thus make comparing studies more problematic. Whilst the health-related outcomes associated with meeting all 24-hr MBs are well documented (Kracht et al., 2024) less is known about young people with learning disabilities. For example, in the review by Huang et al. (2024) only one study included children and young people with learning disabilities. Previous studies have tended to focus on disabilities in general and other conditions such as ASD (Healy et al., 2019), ADHD (Cortese et al., 2009), Cerebral Palsy (Abid et al., 2023) etc. Yet these conditions do not always share comorbidity with learning disabilities. This has led to young people with learning disabilities being underserved within the 24-hr MBs research field. With regards to promoting 24-hr MB adherence, some studies suggest that intervention programs should emphasize engagement of physical activity (PA), reduction of SB and increase in sleep among young people with learning disabilities (Ginis et al., 2021; Taylor et al., 2023). Young people with a range of disabilities and conditions usually face barriers that prevent them from engaging in PA, such as interpersonal and environmental factors (Abid et al., 2023; Lobenius-Palmér et al., 2018). In addition, it is well known that sleep disorders are common in adolescents with learning disabilities which in turn may exacerbate behavioural problems and hinder overall care (Bruni et al., 2025; Stores, 2014). Increased difficulties are also specifically linked to the nature of the learning disabilities that the young person faces whether it be physical, sensory, intellectual or neurodevelopmental (Hao et al., 2024). Disability does not encompass only an individual’s impairment, but also barriers and aspects of discrimination that they may experience in society as a result (Grue, 2016). Young people with learning disabilities might therefore demonstrate lower adherence to the 24-hr MBs and be at greater health risk (Healy & Garcia, 2019; Lu & Zhao, 2023; Taylor et al., 2023). Unfortunately, within the UK there is no quantitative or qualitative data collected with young people with learning disabilities and their adherence to the 24-hr MB guidelines. Previous studies have tended to focus more on specific conditions (i.e., ASD, ADHD, etc.) which may or may not include learning disabilities. Therefore, involving young people with learning disabilities in this present study could help inform the development of interventions to promote adherence to the guidelines in those with learning disabilities. However, there is limited intervention research to date and a lack of interventions available specifically for the learning disabilities population. The UK MRC Guidance on the development of complex interventions recommends that a number of research questions are addressed as part of the early stage of intervention development (Anderson, 2008; Levack et al., 2024). This study aims to fill these gaps by combining quantitative and qualitative methods. The insights gathered will hopefully provide a better understanding of the barriers faced by young people in trying to adhere to 24-hr MBs. This increased understanding may lead to targeted interventions to improve the adherence of 24-hr MBs in young people with learning disabilities. For the present study, learning disabilities is defined as people who meet three specific criteria: (1) global intellectual impairment (intelligence quotient less than 70), (2) the need for support and help to fulfil ordinary daily activities, and (3) the onset before 18 years of age. learning disabilities may have a recognised cause (e.g. Down Syndrome, Williams Syndorme), but often the cause is not known. Young people with learning disabilities often have other physical and mental health conditions, disabilities, and/or impairments as well as having learning disabilities (Gandra et al., 2025).

Objective:

This study aims to provide pilot data to capture 24-hr MBs of young people with learning disabilities in Scotland and their perceptions thereof.

Methods:

Design and recruitment This study will use a mixed-methods approach collecting quantitative and qualitative data. Families will be included if they have a child currently attending an Additional Support Needs (ASN) secondary school in the Greater Glasgow and Lanarkshire areas. We will recruit 60 young people (aged 11-17 years) with learning disabilities and obtain consent from them and their parents. In the first instance, four ASN schools will be approached and informed about the research project objectives and relevance. Participant Information Sheets (PIS) and Parent Information Sheets (PaIS) will be provided for each young person and their family along with consent forms. The research associate will attend each ASN school and provide young people with an opportunity to ask questions. The researcher will also attend a parent’s night/event at the ASN school to allow parents/guardians an opportunity to ask questions about the nature and purpose of the study. This will be arranged shortly after the consent forms, PIS, and PaIS have been given out to allow participants a chance to read through the information ahead of the parent night/event. To ensure we are meeting the needs of the young person, we will consult the schools in terms of which young person should be approached for the study. Ethics Approval All procedures have been approved by the University of Strathclyde Ethics Committee (UEC25/10), and informed consent will be obtained from all participants. Measures Actigraph (GT3x) accelerometers will be used to measure physical activity, sedentary behaviour, and sleep. The Actigraph is a widely used activity monitor which has shown good reliability and validity in this age group and population (McGarty et al., 2016; Rodrigues et al., 2025; Xu & Wang, 2023). Young people will be asked to wear the Actigraph GT3x for a period of 7 consecutive days including weekends. The device will be worn on the right hip, set to a frequency of 100Hz, and 5 second epochs. Parents/guardians will be asked to keep an activity diary outlining when their child has had to remove the device (i.e., bathing, showering, swimming). Parents will also be asked to record their child’s recreational screen time, and sleep-wake times daily. When the device has been returned, the data will be analysed and a unique activity profile chart (Figure 1) will be sent out to each family providing an illustration of the 24-hr MBs (time spent active, time spent sleeping, time spent sedentary and on screens). This chart has been used successfully in a previous study (Dalziell & Janssen, 2023). Adjustments to the chart will be made relative to the age of the participant (i.e., taking into consideration the different recommendations for sleep duration at certain ages), and each participant will receive their chart prior to the interview taking place. Figure 1: Example of activity Profile Chart (Dalziell & Janssen, 2023) Qualitative data will be collected from 10-15 participants in the form of a semi-structured interview. The interviews will take place shortly after providing the participants with their unique activity profile. The unique activity profile will play a central role in discussing the 24-hr MBs aiming to engage the young person during the interview. The interviews will take place within a quiet room in the school that the participant attends. These interviews will allow further insight into 24-hr MBs and enable the researchers to examine the psychological, social, environmental, and wider contextual factors that influence the 24-hr MBs of young people with learning disabilities, including salient barriers and facilitators to engaging in 24-hr MBs. The interviews will draw on a range of psychological and behaviour change theories including COM-B (McDermott et al., 2022), TDF (Caltabiano et al., 2024), Behaviour Change Wheel (Maenhout et al., 2024; Michie et al., 2011) and Self-Determination Theory (Lindsay & Varahra, 2022). Data from the interviews will also explore methodological issues for assessing 24-hr MBs, self-report/parent reliability and validity. Participants will be selected for interview based on their ability to have a conversation and answer simple questions with the research associate. The interview will cover areas regarding the participants understanding of the 24-hr MBs, as well as their views with regards the barriers and facilitators they experience in trying to adhere to the guidelines. Participants may be invited to identify a Support for Learning Worker (SLW) who supports them in school to accompany them during the interview. The interview data will be digitally recorded, analysed systematically in line with the principles of thematic analysis (Braun & Clarke, 2006). Study Procedure Following the consent process, and prior to the young person wearing the Actigraph GT3x, parents/guardians will be asked to complete a questionnaire to provide screen time usage, perceived levels of physical activity, and typical sleep. The researcher will demonstrate how the Actigraph GT3x should be worn along with an explanation of how to fill in the self-report diary that parents/guardians will be asked to complete including sleep-wake times, screen time usage, and when the Actigraph was removed (i.e., for bathing, swimming). Participants providing consent will then be provided with the Actigraph GT3x. Young people will be asked to wear the Actigraph GT3x for seven consecutive days for the whole 24-hours each day, in line with standardised protocols used in previous studies (McGarty et al., 2016; Rodrigues et al., 2025). During the 7 days, participants will not receive any information about the 24-hr MBs but will be encouraged to maintain their usual daily activities. On completion of the seven consecutive days, the activity monitor and self-report activity diary will be returned to the school for the research associate to collect. Upon completion of the tasks within this study, participants will be thanked and sent a £20.00 gift voucher as a token of appreciation.

Results:

The quantitative data collected from the Actigraph GT3x will be presented through descriptive analysis (Evenson & Wen, 2015). The Actigraph provides continuous counts for light, moderate and vigorous activity movements providing a measure at each activity intensity. The advantage of using Actigraph accelerometers is that we can quantify time spent in PA of different intensities. The output in this study will therefore relate to three standard thresholds for activity; light, moderate, and vigorous activity. Total time spent in sedentary (ROC-AUC=0.80), light (ROC-AUC=0.66), moderate and vigorous (ROC-AUC=0.70) intensity PA will be calculated using the Actilife Software V.7.0 along with the Evenson cut-points (Evenson & Wen, 2015). The Evenson cut-points have been selected as they are known to provide excellent discrimination across different intensities of PA (Evenson et al., 2008). To estimate sleep outcomes, algorithms will be used to determine wake and sleep times based on the assumption that recorded movement is indicative of wakefulness and therefore the absence of movement is indicative of sleep. Total sleep time (TST) will be defined as the number of minutes from the onset of sleep to the offset of sleep subtracting the number of minutes awake. This metric has been used successfully in previous studies (Meredith-Jones et al., 2024; Smith et al., 2020). Although a lack of movement can often be recorded during times of wakefulness, and as such mistaken as sleep, the data obtained from the Actigraph GT3x will be coordinated alongside the parent sleep diaries to account for this. Qualitative interview data will be analysed thematically (Braun & Clarke, 2006). Inductive analysis will provide an opportunity to determine how the young people feel about the 24-hr MBs and may provide key insights into the public messaging around the importance of the 24-hr MBs with the learning disabilities population. Deductive analysis will allow us to gain a deeper understanding of the barriers and facilitators experienced by the young people when trying to adhere to the guidelines. This would allow direct links to be made to behaviour change theories and would provide key foundations for future interventions to be designed with the purpose of better supporting young people with learning disabilities to adhere to the 24-hr MBs.

Conclusions:

It is anticipated that this study will help guide future studies and help improve the protocols that are to be adopted with this specialist population. Fundamentally the aim is to gather data to inform the design, implementation and analysis of interventions that support young people with learning disabilities to adhere to the 24-hr MBs. Clinical Trial: Not applicable