Adolescents with intellectual disability (ID) and their perceptions of, and motivation for, physical activity and organised sports

ABSTRACT

Individuals with intellectual disability (ID) are less physically active than individuals without ID, and rarely reach the recommended daily level of physical activity (PA). It is understood that both social interaction and the ability to perform physical work affect participation in daily activity as well as PA. Individuals with ID generally have a higher risk of hypertension and obesity-related cardiovascular diseases than individuals without ID. Professional service providers, teachers and parents are often those being asked about potential challenges related to PA, as it is more seldom that this knowledge comes from the target group (ID) themselves. This identifies a lack of knowledge about PA and sports for individuals with ID. The aim of this study was to identify perceptions of, and motivation for, PA and sports among adolescents with ID. Twelve Swedish male and female adolescents with ID participated in the study, which comprised one semi-structured interview. The interviews identified three main categories: Activity, Surroundings and Body- and health awareness. Adolescents with ID seemed intrinsic motivated to participate in PA, organised sports and activities in general. Support from significant others, teachers, family and friends and support as well as the feeling of joy are connected to normative beliefs which all seem crucial. The participants were aware of their limitations, but sometimes feel bullied and afraid of being excluded, which relates to their normative beliefs. Participation in PA and organised sports may be positively associated with health, but limitations such as lack of awareness and support from society challenge the perception of ‘fitting in’. This research has raised the voice of adolescents with ID and identified the need for increased knowledge of their perceptions for a more inclusive world. School PE is an arena where adolescents can still be reached regarding PA and thereby should be prioritised.

KEYWORDS:

• Activity and sports
• intellectual disability
• adolescents
• perceptions
• physical education; motivation
• beliefs

Introduction

There is a lack of research about participation in physical activity (PA) and organised sports as well as physical education (PE) knowledge, among individuals with intellectual disability (ID) (Apelmo, 2021; McGarty & Melville, 2018). Previous research has investigated e.g. PA patterns among individuals with ID, but research focusing on attitudes, motivation and experiences of PA and health, and effects of impairment and ableism within individuals with ID is lacking (Apelmo, 2021; Mundhenke et al., 2010). Research (Lagestad et al., 2019) in Scandinavia raise that one of the aims in PE is to educate humans to be healthy and productive citizens, whereas other research (Dowling, 2016) has identified that PE seems to have limited influence on adolescent’s time outside school. This actualises the impact of PE and the importance of strengthening the focus on PA also within the lives of young individuals with ID.

In Sweden one percent of the population has an ID (För barn, unga och vuxna med utvecklingsstörning [FUB], 2017). Both children and adolescents with ID are at increased risk of developing health issues than their fully developed peers (Frey et al., 2017). Individuals with ID may display delayed development of cognitive function, difficulties with communication and language (Solish et al., 2010), and find it harder to form social bonds (King et al., 2013). This may lead to problems understanding context and consequences (Hollomotz, 2018).

Research has shown that children and adolescents with ID rarely reach the recommended dose of daily PA, i.e. strength and balance activities ≥2 days per week, within 150 min of moderate-intensity activity spread across ≥3 days per week (WHO, 2018). For example, Sundahl et al. (2016) reported that the average PA level among 52 Swedish adolescents and young adults with ID was far below the World Health Organization (WHO) recommendations, as did Einarsson et al. (2015), who saw similar patterns among young individuals with ID in Iceland. Individuals with ID also have a higher mean body mass index (BMI) (Yanardag et al., 2013), higher prevalence of cardiovascular risk factors such as high blood pressure and obesity (Walsh et al., 2018), decreased motor skills, both with respect to gross and fine motor skills (Pitetti et al., 2017) and tend to have less developed balance control than their peers (Collins & Staples, 2017). Wallén et al. (2013) reported that Swedish adolescents with ID had a higher body fat percentage, wider waist circumference, lower bone mineral density, higher insulin levels and poorer cardiovascular fitness than their peers without ID. Increased participation in PA and body and health awareness could potentially improve all of these factors.

Previous data indicate that only a small number of individuals with ID regularly participate in organised sport for recreational or competitive reasons (Robinson et al., 2018), and compared to fully functional individuals, the proportion is low. In the Special Olympics Movement, individuals with ID compete with others and research reports several motivational factors for participation, including better self-esteem and the opportunity to make social connections with coaches, teammates and opponents (Crawford et al., 2015). Based on a review, by Thomson et al. (2020), significant research is required to better understand how engaging in sustainable and intentional PA or organised sport can support greater community participation, as well as the importance of inclusion for people with ID (Svanelöv et al., 2020).

The motivation for participation in PA and organised sport often includes both extrinsic and intrinsic motifs (Ryan & Deci, 2000a; Ryan & Deci, 2000b). Extrinsic motivation could be described as motivation that originates from other individuals through positive and negative reinforcements; whereas intrinsic motivation comes from within, the feeling of being competent and self-determined to master a task, learn skills and have fun (Weinberg & Gould, 2014).

Research into health behaviours like PA has been carried out from different theoretical perspectives (Frielink et al., 2018). The present study aims to (identify factors) improve the odds of success for longitudinal participation in PA for people with ID. In order to understand the impact of motivational characteristics and insights into the belief system on PA and organised sports, including PE for individuals with ID, it is natural to consider SDT (Deci & Ryan, 1985) complementary with Theory of Planned Behaviour (TPB). In motivation theory there are different types of motivation, for example, in the self-determination theory (SDT) you can find amotivation, intrinsic motivation and extrinsic motivation. Sub-types of extrinsic motivation are ordered into external motivation, introjected motivation, identified motivation and integrated motivation. According to Frielink et al. (2017) there is some initial evidence for a universal use of the four subtypes of extrinsic motivation across both people with ID, and without ID. Underlying SDT are some basic psychological needs like the feelings of competence, relatedness and autonomy, which affect choices made influenced by internal and external factors. SDT has been used to understand motivational processes (Chu & Zhang, 2018) to explain social contextual factors and related outcomes (Frielink et al., 2017; Ntoumanis & Standage, 2009). For individuals with ID, social contextual factors become crucial, and might be of importance when trying to gain insight in these individuals’ perceptions, motivation and belief system. TPB (into behavioural, control and normative beliefs) has been used to explain factors that determine behavioural intentions (Alexandris et al., 2007). To establish a dialogue and to include individuals with ID in the process to understand their behaviours described as needs, preferences and perceived barriers are therefore essential. Curtin et al. (2016) suggest that individuals with ID can, in a reliable manner, report which activities they prefer and vice versa, but are unable to analyse their own performance and self-efficacy.

Through participation in PA and organised sports adolescents, both with and without disability, express ambiguity by being socially active, having fun, developing capability in motor skills and experiencing progression in personal learning and achievements (Mikalsen & Lagestad, 2018; Young-Southward et al., 2017). Ambiguity relates to both positive and negative experiences. In particular, individuals with ID are entitled to both participate in, and express their experiences of, activity and sports according to the United Nation (UN) convention and WHO 2030 sustainable development goals (WHO, 2018). Overall, there is a need to implement and follow up on the UN convention on rights to achieve a deeper understanding of the challenges facing individuals with ID. This knowledge might reveal motivational factors for partaking in PA and organised sports, with special attention required to enlighten stakeholders such as the local community, politicians and the PE system in order to promote adapted implementation, and motivation for long-term success.

To start elaborating and developing this novel area of research, even within a limited population, the overarching aim of this study was to identify experiences among adolescents with ID regarding participation in PA, activity more in general and sports. More specific, the aim was to identify how adolescents with ID express and perceive the opportunities they have, including their motivation for, being active in their community, school and local surroundings. And thereby gaining insights into the belief system underlying participation in PA and the interplay with motivation, i.e. using TPB and SDT.

Method

Participants and data collection

Twelve adolescents (5 boys and 7 girls), aged 16–20 years, with mild ID, participated in the study. ID is defined as having an IQ below 70 and having problems with at least 2 adaptive abilities like to take care of oneself such as hygiene or finances (Holder, 2015). Participants were strategic recruited from a special class in Upper Secondary school in Sweden for this case study. The participants were both able to communicate and be physically active.

The second author first contacted the school, informed about the project and asked for interest of participation. Thereafter the contact teacher invited the researcher to inform in the class. The introduction was done together with the contact teacher. The intention, behind being introduced by the contact teacher, was that the adolescents should feel safe and secure in the upcoming interview situation. The adolescents took part in a semi-structured interview that focused on experiences, motivation and underlying belief factors related to behaviour and participation in PA, organised sport and activity in general in their surroundings.

One-third of the participants lived in group-home facilities during the week (1–10 km from school) during term-time, spending weekends and holidays living with their families further away from the central town. The rest (2/3) of the participants lived with their families all the time.

The interviews took place at the school during the school day and lasted 15–30 min. The interviewer, with previous experience of communication with the target group, conducted the interviews in the period April–November 2018. The interviews followed a semi-structured interview guide, including some open and follow-up questions to encourage the respondents to answer more than just yes or no. The topics concerned: preferred activities or sports outside school hours, activities you liked or/and disliked – feelings and thoughts, activities carried out together with others/friends, do you like activities involving physical movement?, if practicing activity or sports – what kind and why?, do you wish for new activities, what and why?, what is required if you should start/begin a new activity, do some activities or sports happen in the area where you live?, do you want to participate in activities in your surroundings, which - or why not?, decision makers – do they provide something for you to be active in? Have you anything you want to add, or say?

The interviewees were free to talk about other issues during the interviews, even if these were not included in the topics inside the interview guide, since the purpose of these conversations was to explore the target groups’ perceptions and their own way of thinking about the focus areas. The interviews also incorporated follow-up questions when statements or expressions were unclear, and to grasp motives, beliefs, needs and motivation concerning the topic. The interviews were audio-recorded and transcribed shortly after. Quotes from the adolescents with ID, boys and girls, are marked with (R1-12, boy/girl).

Data analyses and interpretation

The data were successively read and analysed, and notes were written including preliminary codes. During the reading process, there were emerging codes and categories that described the adolescents’ beliefs and motivation for PA. The codes were sorted and used to compile stronger sub-categories which in turn could justify the main categories. When performing qualitative content data analysis a basic issue is to decide whether the analysis should focus on manifest or latent content. Analysis of what the text communicates deals with the content aspect and describes the visible, obvious components, referred to as the manifest content (Downe-Wamboldt, 1992; Kondracki et al., 2002). Analysis of what the text communicates about, deals with the relationship aspect and involve the interpretation of the underlying meaning of the text, referred to as the latent content. Both manifest and latent content analysis use interpretation, but the interpretation varies in depth and level of abstraction. This study involved both approaches of analysis elaborating the data, where the manifest approach was used for interpretation, and the latent approach was applied to understand perceptual aspects of the data (Kvale, 1983).

The main categories summarised the results covering the most mentioned aspects regarding what kind of activities the adolescents had, or would like to have, experience with, as well as reflections regarding their surroundings, body and health. This information and identification of facilitating challenges was sorted by the manifest content analyse approach. The adolescents’ expressions regarding their belief and motivation related to PA, including a focus on body and health, as well as circumstances in their surroundings, was sorted into sub-categories. This information was interpreted, by a latent approach, with the intention to better understand their TPB beliefs (Fishbein & Ajzen, 2010), SDT motivation (Deci & Ryan, 2000) as perceptions connected to PA and organised sport. To strengthen and increase the validity and credibility of the data material, all three of the authors read through and coded the interviews separately. After reconciling any inconsistencies, the authors then discussed preliminary codes and sub-categories, compared it to the transcript of the interviews and continued this dialogue until the saturation process agreed about three main aspects treated as categories.

Ethical considerations

The Swedish Regional Committee approved the study (Dnr 2017/510-31). The informants received written, text adapted for this target group, and oral information about their option to withdraw from the study without giving any reason. The informants gave written consent to participate in the study. The data were anonymised and stored according to the Swedish Act on Ethical Review on Research Involving Humans (SFS 2003:460 (2005)).

People with ID need support, patience and a predictable structure (Hollomotz, 2018). Therefore the project, represented by the researcher performing the interviews, needed support from the (PA) school teacher especially in the beginning for recruitment and building confidence. This preparation resulted in a successful data collection where interviews without any withdraw were carried out in the adolescents’ safe environment. Direct involvement from the (PA) school teacher(s) was obligated, and community leaders, staff, trainers and significant others is crucial for conducting and elaborating these kinds of studies.

Results

During the interviews three main categories were identified: 1. Activity, 2. Surroundings, 3. Body- and Health awareness. The main categories, summarise the impressions from the study, and were further divided into sub-categories like: 1. Activities; (a) PA & sports, (b) Activity in general, 2. Surroundings; (a) Social and significant others, (b) Motivation, (c) Facilitators and support, 3. Body-and health awareness; (a) Physical health, (b) Mental health. These sub-categories were headings for examples of expressions and reflections given by the adolescents with ID. The results present adolescents with ID’s perceptions of PA by sharing their needs, preferences, beliefs and perceived barriers as well as their motivation behind PA behaviour.

Activity

Adolescents with ID seemed intrinsic motivated to participate in PA and organised sports. The role of significant others, family and friends, teachers, support and the feeling of joy, associated with normative and control beliefs, all seem crucial when reporting activity as being outdoors, participating in ball games and in music activities.

Examples of activities brought up by the adolescents were: individual and team sports such as running, skiing, football, basketball, bandy, badminton, tennis and swimming; outdoor activities such as hunting, fishing and hiking; taking care of animals such as horses or walking a dog; dancing and motor-cross. Adolescents with ID express the need for support from significant others, such as family, friends, coaches and (PE) teachers. Support, or lack of support as a perceived barrier, influenced their motivation. The perceived benefits of PA are connected to intrinsic motivation, involving health benefits and psychosocial needs. To socialise with others and have fun seemed to be of great importance also in order to take action for increasing PA.

• (a) PA/Sport:

The majority expressed interest in, and experience with, PA and organised sports. Even so, more than the majority (2/3) add that they have experienced less or no adapted activity or equipment. This lack of facilitation affect behavioural beliefs for conduction PA and organised sport, since the adolescents needs then not are accommodated.

When questions were asked regarding what was most important in order to be active, the answers seems to be divided into positive and negative factors given by emotional responses connected to perceived barriers, psychosocial needs and intrinsic motivation.

(R11, girl) ‘Hard and fun … // … yes, I used to … actually … hard to understand certain things and so on. Then it could feel a bit hard to join in

(R11, girl) ‘Yes, if it is something I enjoy, then I like it and then it gets fun’

When asked about what is important with new activities and what they do like or not like, physical, mental and practical limitations were brought up. Still, the motivational aspect of interest and enjoyment are those being brought up. At the same time, the adolescents self-awareness regarding limitations might explain both the behaviour and expressions of psychological needs by aspects for understanding, to be understood as well as limited accessibility.

(R7, boy) ‘That I like it. That I have some interest in it … // … First of all, my fitness level is bad, then it is kind of because I have a disability’ … // … ‘But, (it is that) I have difficulties to learn  … // … More that I think it is hard for me. And, I also live quite far away and I’m only here seven days a week (probably refers to five days a week, not weekends)’.

Distance and where they live seemed to play a certain role. Another example, from one of the respondents, when she talked about her habits of being active, was how challenging it could be when moving to a new place. The underlying belief for, and expressions of, needs that facilitates a continuing of PA became clearer.

(R4, girl) ‘No support – played football where I lived before. It never happened that I started again’

Half of the group expressed enjoyment in school practical PE and sports after school, and they described their perceptions of practice activities such as running and games as a positive feeling of moving outdoors and being in nature. The adolescents described their good emotional feeling and benefits of being active. Again, this behavioural belief seemed connected to their autonomy and intrinsic motivation as a result of feeling competent.

(R4, girl) ‘Things that I am good at, I do like … // … Hmm, I used to participate in badminton competitions and tennis in year six, then I quit … // … yes, because it was fun and about, and doing something after school’

(R6, boy) ‘I feel better when I am in the forest’

• (b) Activity in general:

Some of the adolescents listened to, or made music, or engaged in other hobbies such as baking, painting, watching TV/Film and gaming. The use of the computer often occurred alone, and sometimes with others; the social interaction came in as an additional factor. The following descriptions are examples characterised as other activities than PA and organised sports. The adolescents endorsed the importance of both PA and activity in general, and particular the positive benefits. The psychosocial aspect was visible in the way they described their perception towards increased health and belief in their own competence. At the same time, this enthusiasm is balanced with the fear of failure.

(R11, girl) ‘Ehhh … listen to music and dance … and … and sing to the music … // … ehhh … I become glad of it and things like that … .// … preferably on my own … // … ehhh … because otherwise … like dare not, well, I do not dare to dance’

(R2, boy) ‘Write song lyrics, I shall be a lot smarter, years, facts … // … Like to be together with others, write lyrics with famous people’

Alternatives to partaking in PA and organised sport could be the adolescents’ interest of and experience with motor sports, painting and taking care of animals. These activities seemed to be connected to intrinsic motivated behaviour, and contributes to social acceptance and competence.

(R9, girl) ‘It is mostly driving snowmobile, then when you can drive snowmobile and then … That I like a lot.

Surroundings

Adolescents with ID interacted with their surroundings, but were aware of limitations, sometimes felt bullied or were afraid of being excluded which can be connected with behavioural and control beliefs. Examples of significant others brought up by the adolescents were: family (siblings, mother, father and grandparents), teachers, friends and animals. Normative beliefs became visible through the support they described from people they believed would support them and approve if PA was carried out or continued.

• (a) Social/significant others:

Eleven out of 12 talked a lot about their family, friends and the importance of having fun during the activity itself; being happy and laughing. For the adolescents with ID knowing someone and having friends was an important factor for being active.

(R6, boy) ‘Yes, because my brother started, I also started’.

(R10, girl) ‘My friends wanted me to join and play when we were in primary school’.

Half of the adolescents discussed parents and near family, but some did not talk about their parents at all. They instead raised the importance of support more in general as an important factor when considering to start a new activity or sport. School was described as an arena where the adolescents meet friends and socialise during lessons and breaks.

(R6, boy) ‘Yes, it is in school that … // … Yes, you are that, you do lessons and stuff. Be with friends during the breaks and … on one side and the other’.

When it came to decision makers in society and the offering of activities that would allow the target group to be active, the reactions seemed divided.

(R9, girl) ‘Like in X (place 10 km outside town) I think that the offering of activities is pretty bad or what should you say. Umm …  it is more young people that go in to town and do exercise instead of for example in X. And the same in Y (another place 25 km outside town), it is like more people going in to town, I do not know why but …  it is probably because there is not so much to choose from’.

Taking care of animals seemed to keep several of the participants both active and social, as well as the feeling of mental support.

(R12, girl) ‘Horse – want to take care of and help others’

The most important things while doing something with friends seemed to be the socialisation with fun and like-mindedness.

(R4, girl) ‘Uhmm, it is like to be social with each other, talk to each other, yes … .// … Yeah,, to be able to in some ways agree about what you want and things like that’.

Some address the aspect of feeling reserved towards doing activity with others.

(R11, girl) ‘Do not want to dance together, do not dare’

• (b) Motivation:

Regarding motivation, the adolescents with ID expressed repeatedly the importance of acting social, making agreements with friends and importance in choice of activity. Intrinsic motivated actions, and behaviour beliefs could be connected to fulfilment of needs of making agreements as well as feeling of acceptance.

(R12, girl) ‘That everyone shall have common … actually … everyone should agree. And like that all gets to be involved to decide … I think’.

(R1, boy) ‘Fun – find something that everyone likes to do, socially, motivation’

Some of the adolescents think it can be difficult to understand the environment, be conscious of and reflect on what is the best for them.

(R11, girl) ‘Hard to understand the environment’

(R4, girl) ‘Everyone should feel well – everyone does not do that, feel safe, be honest about what feels good, bad to be one of the lazy ones – the body gets stiff’

The adolescents expressed that those living in a youth group-home (adapted boarding school facility during weekdays) would like to have more support to get out. Some even brought up that it is hard to change place to live and hard to come into something new when moving into a youth group-home.

• (c) Facilitators/support (human) & location:

Half of the group expressed enjoyment in school, activity and sports and highlighted the significance of school as one social setting arena becomes an important facilitators for PA. Half of the participants asked for more activities that are possible for them to attend. They spoke about the enjoyment of outdoor activities. Half of the group identified the need for outdoor space and possibilities for being active, because they have the experience of too few or not enough tailored activities. Examples of locations identified for activity and sports were school, home, group-home facilities, sports clubs, gyms, parks and nature, as well as arenas in the city and in the countryside. All aspects are closely connected to their control belief.

(R11, girl) ‘Ummm … I followed my friend to his/her football training. And then I reflected like this, wanted to start with football or not, and then I wanted to’.

The adolescents were asked what they would like more from people who decide in the society. This question was interpreted differently. In the adolescents’ world the decisions makers were parents, teachers and personnel at the youth group home facility or politicians. Different stakeholders facilitate and inform about activities to choose between. Several of the adolescents seemed already satisfied with what they are offered while some would like more information about what is possible to do and more different sports to choose between.

(R12, girl) ‘That the ones who decide makes sure that there are more things to choose from – everybody wants to have different activities’.

(R1, Boy) ‘Like, I just think that they do it very well. I am not so familiar with politics and things like that, but I think somehow like they do it pretty good … // … They build new playgrounds and new schools and  … ’.

Several examples from the adolescents indicate awareness of arenas. The motivational part of doing an activity in familiar surroundings is one thing, but the accessibility and the capability must be maintained to achieve sustainability in activity participation.

(R1, boy) ‘Eh, you have XX (athletics and football arena), then you have YY (the park next to the water) you have, you have ZZ (the ski stadium), yes there is a lot … .// … Not super much, I have been at XX now and then I guess, the ZZ too … .// … Not ZZ, but XX I have been with school’.

Body- and health awareness

Participation in activities and sports may be positively associated with health. In relation to partaking in activity, at least half of the adolescents brought up mental health aspects like: focus, relieving stress, clearing thoughts, relaxing and release of anger as positive reinforcements, and to cope with negative feelings. The adolescents expressed both consciousness and clumsiness regarding both their physical and cognitive limitations. Some brought up examples like: it is hard to understand, need for a social secure context, the shape of the foot, having overweight or bad cardiorespiratory fitness. The aspects concern the adolescents’ behavioural belief and indicate basic psychological needs.

• (a) Mental health:

Mental health were both sorted into negative and positive aspects.

(R7, boy) ‘I am not into leisure activities, hard with fitness, the disability makes it hard to learn, bullied’.

The benefits of doing activity outdoor and staying in nature are intrinsic motivated.

(R9, girl) ‘And go hiking in the mountains that I also like to do … // … hiking … you get a lot of air into your lungs … you get tired in the evening and it feels really like you has done something’

Others are aware of the connection between activity and food for achieving health benefits.

(R2, boy) ‘Yeah, I usually uhmm exercise, run air-cycle (refers to cross-trainer), also throw ball, exercise the abs and foot-heels (refers to calf muscles) … // … I have stopped sugar one … one week, two weeks so-so … // … I should not eat too much sugar … .// … No, it is not good for the body. Not hea … hea … health’.

The adolescents’ with ID talked about a combination of reasons connected to their mental health. At the end in one of the interviewees also expressed her gratitude of being heard.

(R8, girl) ‘Thank you for letting me participate. I think that it is good that you not only ask me about what I like, but also why I like something. That, I am thinking, is good’.

• (b) Physical health:

Participation in PA and organised sports was perceived by the participants as positive for several reasons connected to physical health. The importance of learning and adapting new skills seems to be one of these reasons and social interaction becomes an additional benefit.

(R5, boy) ‘Yeahhhh, it’s … for example basketball, I used to do quite a lot, so then more learning also about basketball I can exercise quite a lot also I used to be outside and play golf in the summer. There I get to be outside and get a lot of fresh air, ummm, I get at the same time exercise and at the same time learning also in the same time … // … you learn to know more different kind of people and at the same time have fun’.

The participants reflected on their ability to perform and their physical disabilities. To cool-down was a mental exercise for achieving physical improvement, whereas several sports and activities in general contributed both to physical and mental achievements. Adolescents with ID seemed motivational driven by the feeling of competence having skills, and reflected both over outcomes of PA versus inactivity.

Discussion

The overarching aim of this study was to identify experiences among adolescents with ID regarding participation in PA, activity more in general and sports. More specific the purpose was to identify how adolescents with ID express and perceive the opportunities they have, including their motivation for, being active in their community, school and local surroundings. The study identified activity, surroundings and body- and health awareness as main categories. These results can contribute to both the professional knowledge and common knowledge, and might increase the insights and reflections connected to decisions made concerning facilitation and priorities connected to PA, organised sport and activity in general. The study became, and identified, a complex relationship between motivations and beliefs factors underlying PA and organised sport. By combining two established theories in PA research, TPB and SDT, the study revealed complementary sides between the two theoretical constructs.

Repeatedly, the data material actualise that adolescents with ID need support from family, friends, coaches and teachers in order to take action for increasing PA. This exemplifies the need of significant others and a social context, that might impact the motivation, and are similar to factors of importance for PA found in the study of Michalsen et al. (2020) and Strandbu et al. (2020). The feelings of joy, competence or skills, and interest for participating in the activities were raised several times by the adolescents which identified their behavioural beliefs (TPB) and explain the need for intrinsic motivation (SDT) to engage in PA. The adolescents with ID cited perceived internal and external barriers to PA as they were aware of their own physical and social limitations. This might reflect their behavioural and control beliefs, when they report this in combination with a lack of adapted activities and equipment.

The adolescents expressed both consciousness and clumsiness regarding both their physical and cognitive limitations. Some brought up examples like: it could be hard to understand, having the feeling of a socially secure context, the shape of the foot, having overweight or bad cardiorespiratory fitness. This could be related to the lack of adapted activities, both in the sense of physical training load and pedagogically adapted instructions, and the lack of inadequate equipment, and might be connected to delayed development of cognitive functions such as difficulties with communication and language (Solish et al., 2010), as well as having harder to form social bonds to other individuals (King et al., 2013). Cognitive functions might turn into problems for understanding context and consequences. This resonates with participants’ expression on difficulties to learn, and they thereby or indirectly identifies the need for adjustments in the pedagogical instructions during an activity to ensure the feeling of self-esteem and social inclusion. The adolescents mentioned that they would like to do activities and sports also after school, including being outdoors, but are not able to because the distance to travel is a hinder to manage on their own.

Other activities, such as listening to music, watching sport and baking contributed to improved mental health through a feeling of wellness, increased socialisation when doing it together with others, and overall satisfaction. This way of being engaged becomes a more sedentary character of PA, but still counts as socialisation and partaking in society. This could somewhat explain and agrees with research which indicates that only some individuals with ID regularly participate in PA for recreational or competitive reasons (Robinson et al., 2018).

It is known from the Special Olympics Movement that individuals with ID compete in sports and research point out several motivational factors such as increasing self-esteem and giving the opportunity to make social connections with coaches, teammates and opponents. Toward the best of our understanding, the Special Olympics Movement and the findings from the present study share a common goal for the respective participants in providing social opportunities to interact with others. This allows us to conclude that both adolescents with ID in general, and the ones who are active through the Special Olympics Movement, are signalling a need for socialisation. This challenge the school system and the PE as advocates for facilitation of the feeling of inclusion in both PA, organised sports and the society as a whole (Crawford et al., 2015; Robinson et al., 2018).

Additionally, some of the participants from the present study mentioned mental and physical health benefits when going to the gym, such as improved mood and fitness. Reluctance was present due to feelings of being afraid and feeling shame of their physical appearance and capabilities. These findings could relate to the participants’ basic psychological needs (SDT) like the threat of not feeling competence, and thereby contribute to an amotivation. This knowledge can be viewed in light of, and added to, the fact that a large number of individuals with ID have decreased motor skills (Pitetti et al., 2017) and less developed balance control than their peers (Collins & Staples, 2017). This underpin why we are obligated to bring more increased knowledge into PE and increase the competence on how different stakeholders meet and communicate with adolescents with ID. School and PE is one of the important facilitators of PA at an early age, where frames and opportunities for PA and sports naturally could and should be exploited.

Results from the present study regarding surroundings, involve social participation in relation to significant others, facilitators and also the effect on motivational factors. Less physical distance and increased availability are examples of actions were individuals with ID might perceive access to locations as less stressful, as proximity to locations for PA can present both physical and mental barriers to participation. Facilitators at school, in the community and at the place of residence, can both physically and mentally influence how individuals with ID perceive things in connection to their surroundings. The significance of social contact, and support might be connected to relatedness as a basic psychological need, and the intrinsic motivation seems important by the positive emotions visible throughout the results. The importance of family sport culture in the teen ages might be comparable, and even strengthen these findings (Strandbu et al., 2020). Autonomy-supportive communication in PE is discussed by Chu and Zhang (2018), and might be relevant to discuss further in connection to present study. The adolescents express the need for influencing, experienced by the feeling of autonomy, as well as recognition through relatedness and competence. This to be both intrinsic motivated, as well as extrinsic motivated including the sub-types of external motivation, introjected motivation, identified motivation and integrated motivation recognised in parts of the sub-types or as a combination, like in Frielink et al. (2017) where they mention the universal use of the four subtypes of extrinsic motivation across people with ID. The adolescents speak warmly about being with friends at school in lessons, during breaks and after school. PE teachers become a natural part of these adolescents’ surroundings and thereby as external motivation and essential for the relatedness during the school day.

The current study exemplifies how practical and motivational challenges occur when adolescents live 10–25 km away from school and city centre, a long distance for these adolescents. These long distances diminish the opportunity for participation in PA and activity in general as it might become almost impossible outside school hours, and by this their autonomy is withdrawn. As motivation for partaking in activity and sports often includes both extrinsic and intrinsic motifs (Ryan & Deci, 2000a; Ryan & Deci, 2000b), this example mentioned above of surrounding factors and circumstances discriminate the target group. As a result of the lack of opportunities, the participants displayed reduced opportunity for self-determination (autonomy) and having fun (intrinsic motivation) which are similar to reflections found by Weinberg and Gould (2014). In this case, this could be seen as negative reinforcements.

To establish the dialogue, to include individuals with ID in the process, we have to listen and try to understand their perceptions and behaviours based on past PA behaviour, influenced by motivation and sociodemographic factors. The behaviours might be described as needs, preferences and perceived barriers, and the factors that determine behavioural intentions can be explained and understood by behavioural beliefs connected to attitudes, control beliefs connected to perceived behavioural control, as well as normative beliefs related to the subjective norm, were more or less all influence on the behaviour intention and behaviour in practise (Alexandris et al., 2007). As Curtin et al. (2016) suggest, individuals with ID can, in a reliable manner, report which activities they prefer. In the present study they also partly analyse or reflect on their own past PA participation and performance, and reflect upon behavioural intention for PA. This intention might be the most immediate predictor for future PA. The stronger the intention becomes, the more likely PA will take place and increased. Behavioural consequences and the evaluation of them seemed to be of importance for individuals with ID. This is closely connected to social expectations of significant others towards their behaviour where the motivation complied the expectations. Last, but not least, the perceived control factors, facilitating strength or inhibit their behaviour performance has to be at focus in this work.

This is in line with the self-determination thinking by Deci and Ryan (1985), and should be taken into account by stakeholders to understanding the impact of PA and organised sport, including PE, for individuals with ID (Apelmo, 2021). Self-determination theory has been used to understand motivational processes in PE, and autonomy-supportive communication in PE are discussed by Chu and Zhang (2018) to explain social contextual factors such as the feeling of a secure, enjoyable and familiar environment and related outcome for both mental and physical health (Ntoumanis & Standage, 2009). For individuals with ID, somehow a vulnerable target group, such knowledge becomes evident. Results from the present study regarding body- and health awareness visualise how individuals with ID interpret information about what good health is and means, and how they utilise that information to improve their own health. Expressions from the adolescents reflected health literacy, by the awareness regarding the importance of being more active and intake of less sugar. This is in line with both more general and specific health recommendations (WHO, 2005; 2018). In connection to the participants’ physical health, and our previous knowledge that individuals with ID, in general, have a high mean body mass index (BMI) (Yanardag et al., 2013), and a higher prevalence of cardiovascular risk factors (Wallén et al., 2013). All these indicators for cardiovascular health including high blood pressure and obesity, this project might actualise these challenges. Explained by an increased consciousness that cardiovascular challenges can be prevented, or at least rehabilitated by increased awareness and action among the target group themselves, as well as increased focus from stakeholders such as people that contribute with support, education directly and indirectly.

Previous research and additional results from the present study raise concerns and call for attention in the future. The findings emphasises demand for custom-tailored physical activities to favour and promote health among individuals with ID, which they according to the UN convention concerning rights for individuals with a disability ([SÖ] 2008:26) have the right to as citizens of Sweden. The convention concludes that individuals with ID have the same rights to participate in any form of recreational or PA and should be able to do so at their own level. Hence, actions to: (1) Encourage and promote participation in available sporting activities, (2) Ensure the possibility to participate in sports or recreational activities which is adapted for individuals with ID and (3) Ensure that suitable facilities exist, has to be taken. That includes updated PE variation and implementation, as well as including effects of impairment and ableism as discussed in Apelmo (2021) were dis/ability and PE teacher education for individuals with ID.

Individuals with ID could and should increase their participation in societal activities such as sport and PA and hence feel more active, healthy and included as citizens. As we can learn from these interviews, significant others make it possible both practically as well as emotional supportive reasons inside the interactional levels. For individuals with ID, the combination of initiative from significant others, as well as feelings of joy, support and inclusion are identified as essential which is similar to recommendations we find in Michalsen et al. (2020) concerning the development of PA interventions for individuals with ID. Special attention is given to include stakeholders (school, PE teachers, politicians) and the sport education knowledge in order to promote implementation and long-term success. In this way, we hope that the present study may also contribute to a deeper understanding of how to implement and follow up on the UN convention on rights for individuals with ID, as well as explore the 2030 sustainable development goals.

Limitations of the study

People with ID need the feeling of support, patience and a predictable structure during project involvement. Therefore, direct involvement from the (PA) school teacher(s) was obligated because of their relation to the target group as well as advocating role for PA. The low number of respondents do not give transferability among adolescents with ID regarding activity and sports, but might contribute to an insight of understanding their perspective. By limited population, the authors mean that the study was conducted in only one upper secondary school within a special class including the target group. The information seemed interesting, sparse and could reflect special circumstances connected to the community nearby and not be generalised. As a contribution and opportunity the authors still want to highlight is the importance of giving the adolescents with ID a voice in the research regarding PA and organised Sports, and additionally enhancing stakeholders’ knowledge.

Conclusion

Adolescents with ID seemed intrinsic motivated to participate in PA activity and organised sports. The role of significant others, teachers, family and friends and support as well as the feeling of joy are connected to normative beliefs which all seem crucial. Adolescents with ID are aware of their limitations, sometimes feel bullied and afraid of being excluded this relates to their behavioural beliefs. Participation in PA and organised sports may be positively associated with health, but limitations such as a lack of awareness and support from society challenge the perception of ‘fitting in’. The voice of people with ID deserves to be listened to by the education system, the sports associations, the politicians and the society as a whole. This research has raised their voice and identified the need for increased knowledge for a more inclusive world. School PE is an arena where adolescents can still be reached regarding PA and thereby should be prioritised.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was partly financed by the Rolf and Gunilla Enström Foundation.