Pushing forward: Understanding physical activity in adults with medical complexity.

Background: Adults with severe and profound intellectual disabilities (SPIDs) often encounter more significant healthcare needs than those without disabilities. People with SPIDs are more likely to have mobility impairments (MIs), yet little is known about physical activity (PA) experiences among those with SPIDs and MIs once they transition out of pediatric and school-based settings. This study explores the experience of PA in adults with SPIDs and MIs based on clinician perspectives. Methods: Eight clinicians engaged in a semi-structured interview and described their experiences with PA in adults with SPIDs/MIs. Interviews were analyzed to determine common themes, and a reflexivity journal and field notes were used to corroborate and supplement findings. Data was organized according to the 5 socio-ecological model (SEM) levels and 16 a priori themes (1) intrapersonal: attitudes, physical factors, knowledge, and values, (2) interpersonal: supports outside the home, supports within the home, and home environment considerations, (3) organizational: disability-inclusive organizations, academic institutions, and medical institutions, (4) community: environment and priorities, and (5) policy: home and community-based services (HCBS), financial, academic and programming, and accessibility policies. Clinician-identified barriers and facilitators to PA were grouped under these 16 themes. Results: The 5 most prevalent PA facilitators included (1) PA preferences as uniquely individualized, (2) organizations providing PA for adults with multiple disabilities, (3) building, outdoor, and transportation accessibility, (4) the importance of allyship and socialization among those with SPIDs/MIs and between caregivers, and (5) advocacy for promoting monies toward prevention instead of illness. The 5 most prevalent barriers to PA were (1) building, outdoor, and transportation inaccessibility, (2) necessity of education on needs and opportunities for PA, (3) diagnosis, bodily structure, weakness, or pain in adults with SPIDs/MIs, (4) lack of competitive billing structure to support PA programs or clinician reimbursement, and (5) lack of HCBS education and support. Implications: Recognizing the interplay of each SEM level and factors influencing PA engagement may improve access and health outcomes among adults with SPIDs/MIs. Clinicians play a significant role in assessing, educating, and promoting PA opportunities for people with disabilities as they transition into and age within adult and community settings.