| Background: Health-related quality of life(HRQo L)is an area of quality of life which can be evaluated from physiological,psychological,and social facets.Due to the evident limitations in intellectual functioning and adaptive behavior,children and adolescents with intellectual disabilities(ID)showed lower level of HRQo L than their peers without disabilities.In recent years,studies on the 24-hour movement behaviors including physical activity(PA),sedentary behaviors(SB),and sleep have been paid more attention in healthy research areas.The 24-hour movement guidelines released by Canada in 2016 offered comprehensive and scientific suggestions for nurturing a healthy lifestyle in children and adolescents.It has been suggested that adhering to all three of the 24-hour movement guidelines could improve HRQo L of children and adolescents with typical development.To our knowledge,however,little is known about the associations between meeting the 24-hour movement guidelines and HRQo L in children and adolescents with ID.Purposes: Based on the International Classification of Functioning,Disability and Health(ICF),the main purpose of this study was to examine the influences of 24-hour movement behaviors of children and adolescents with ID on their HRQo L,which can provide effective paths for improving HRQo L in this population.Specifically,we aimed to: 1)assess the associations between adherence to 24-hour movement guidelines and HRQo L among children and adolescents with ID;2)examine the influences of 24-hour movement behaviors of children and adolescents with ID on their HRQo L;and 3)analyze the mediating effects of the psychological health status of children and adolescents with ID between 24-hour movement behaviors and their HRQo L.Methods: Convenience sampling and purposeful sampling were used to identify possible participants,ultimately recruiting 319 children and adolescents with ID from two Chinese special schools in Ningxia Hui Autonomous Region.PA and nocturnal sleep were objectively measured using Actigraphy GT3 X accelerometers.Parents or guardians of participants were asked to respond the Screen Time Questionnaire of Children and Adolescents with Disabilities,the Strengths and Difficulties Questionnaire,and HRQo L Questionnaire of Child and Adolescents with Disabilities.Linear mixed models were used to examine the differences in HRQo L between meeting and not meeting various recommendations in the full sample.A purposeful and random sampling was used to identify the interviewees whose children with ID followed different adherences to the 24-hour guidelines.Semi-structured interviews were done on 40 parents or guardians on the influences of 24-hour movement behaviors on their children’s HRQo L.Structural equation models were constructed based on the above mentioned studies,and influences of 24-hour movement behaviors on HRQo L in children and adolescents with ID were tested through their psychological health status.Results: 1)Only 17.55% of the participants met all the three movement behavior recommendations.Adherence was lowest for moderate-to-vigorous PA(MVPA)and highest for sleep in this study.Parent-proxy average score for HRQo L of participants were 56.46 ± 15.49.In the full sample and those with severe ID,meeting MVPA,MVPA + ST,MVPA + sleep,and all three recommendations had significantly better HRQo L than those who did not meet these guidelines(p < 0.05).In participants with mild ID,meeting sleep and sleep + ST had significantly better HRQo L than who did not meet these guidelines(p < 0.05).2)The part on qualitative study tested the ICF and indicated that the 24-hour movement behaviors of children and adolescents with ID influenced their HRQo L through physiological,psychological,and social facets.Physiologically,24-hour movement behaviors influenced HRQo L of participants mainly by promoting physical health,improving daily living activities,and sleep quality.Meanwhile,psychologically,24-hour movement behaviors influenced HRQo L of participants mainly through emotional symptoms,cognitive abilities,characteristics,and will power.Finally,socially,24-hour movement behaviors influenced HRQo L of participants mainly by improving interpersonal relationships,enhancing social adaptability,and improving daily behavior performance.3)Models of MVPA,ST,and sleep influence HRQo L explained 20.4%,18.0%,and 18.5%variance of HRQo L,respectively.Psychological health had a mediating effect between 24-hour movement behaviors and HRQo L.Specifically,emotional symptoms and prosocial behaviors had a mediating effect between MVPA and HRQo L.Participants with higher levels of MVPA had fewer emotional problems,more prosocial behaviors,and higher HRQo L.Emotional symptoms and prosocial behaviors also had a mediating effect between ST and HRQo L.Participants with longer ST had more negative emotions,reduced prosocial behaviors,and lower HRQo L.Finally,emotional symptoms,hyperactivity-inattention,and prosocial behaviors had a mediating effect between sleep and HRQo L.Participants with sufficient sleep had fewer emotional problems and hyperactivity-inattention,more prosocial behaviors,and higher HRQo L.Conclusions: Children and adolescents with ID in western China who met MVPA and combinations of it(MVPA + ST,MVPA + sleep,and MVPA + ST + sleep)had significantly better HRQo L than those who did not meet these guidelines.Participants meeting all three recommendations had the best HRQo L scores.Meeting various combinations of the MVPA resulted to significantly better scores in physical functioning,psychological functioning,social functioning,and school functioning.24-hour movement behaviors had effects on HRQo L through physiological,psychological,and social facets in children and adolescents with ID,which tested the ICF used in the study.Emotional symptoms,hyperactivity-inattention,and prosocial behaviors in the psychological facet had a mediating effect between 24-hour movement behaviors and HRQo L.The interventions on 24-hour movement behaviors among children and adolescents with ID and MVPA of those with severe ID should be addressed in the future studies.Moreover,the psychological health status of the target population should be given more attention for the promoting healthy lifestyles. |
