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Article

A Mixed Methods Analysis of an Adapted Fitness Program for Adults with Intellectual and Developmental Disabilities

by
Melissa N. Savage
1,*,
Andrew M. Colombo-Dougovito
2 and
Farwa Kelly
3
1
Department of Curriculum and Instruction, College of Education and Health Professions, University of Arkansas, Fayetteville, AR 72701, USA
2
Department of Kinesiology, Health Promotion and Recreation, College of Public Affairs and Health Services, University of North Texas, Denton, TX 76205, USA
3
Department of Educational Psychology, College of Education, University of North Texas, Denton, TX 76205, USA
*
Author to whom correspondence should be addressed.
Disabilities 2026, 6(2), 27; https://doi.org/10.3390/disabilities6020027
Submission received: 19 November 2025 / Revised: 24 February 2026 / Accepted: 10 March 2026 / Published: 17 March 2026
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Abstract

While many benefits exist from regular engagement in physical activity (PA), adults with intellectual and developmental disabilities often do not engage in the recommended levels of PA needed to access those benefits. Barriers, such as a lack of accessible environments or knowledgeable support staff, have been shown to limit participation in PA. This study used an explanatory sequential mixed methods approach to, first, examine the quantitative fitness outcomes of 31 adults with intellectual and developmental disabilities enrolled in an adapted fitness program, followed, second, by inspecting qualitative field observations of fitness classes and interviews with their fitness instructor for possible explanations of the earlier findings. Quantitatively, there was a significant reduction in body mass index after 12 months of participation, while additional fitness outcomes (such as situps and balance) were maintained. Qualitative findings from conducted field observations and interviews provided a possible rationale for these quantitative outcomes. Five themes were generated: (1) personalized goal setting; (2) progressive challenge; (3) safe and flexible environments; (4) connection and belonging; and (5) celebration of progress. These findings, in total, highlight the importance of building capability, providing opportunities, and incorporating motivational strategies to ensure that adults with intellectual and developmental disabilities can achieve positive outcomes from PA engagement.

1. Introduction

Physical activity (PA) plays a critical role in overall health and well-being for individuals, such as reducing risk for chronic illness, cardiovascular disease, and depression [1]. While PA engagement can support overall health, adults with intellectual and developmental disabilities often do not engage in an appropriate amount of physical fitness activities and are shown to have lower levels of physical fitness compared to non-disabled peers [2,3]. More specifically, adults with intellectual and developmental disabilities tend to have lower levels of cardiovascular fitness [4] and muscular strength [5,6], which can greatly impact their quality of PA engagement. Additionally, lower levels of PA engagement documented in individuals with intellectual and developmental disabilities may contribute to poor health outcomes and increase risk for secondary conditions, such as heart disease, diabetes, and obesity [7,8,9,10].
Lowering the risk for secondary conditions can be difficult for individuals with intellectual and developmental disabilities due to a variety of barriers to PA engagement, such as: (a) a lack of motivation [11]; (b) less opportunity to take part in organized activities [12]; and (c) not having access to transportation [13]. Additionally, there is typically a lack of knowledge from fitness professionals (e.g., limited understanding of how to make adaptations and fitness professionals’ lack of preparation to work with individuals with disabilities [14]). Some common issues include a lack of: (a) fitness professionals with specialized training in disability issues; (b) prior experience in therapeutic exercise; and (c) information about prescription medications and their effect on exercise [15].
However, when individuals with intellectual and developmental disabilities participate regularly in PA programs, the multidimensional benefits experienced by individuals can span across the physical health, cognitive functioning, and social well-being domains. Multiple studies have shown that habitual successful engagement in PA can result in marked improvements in health outcomes [16,17,18] and meaningful increases in social interaction [11,19]. There is also moderate to strong evidence that PA improves balance, muscle strength, and quality of life in persons with intellectual and developmental disabilities [20,21]. Beyond these outcomes, engagement in moderate- and vigorous-intensity aerobic activity (a specific form of PA) has been shown to improve cardiovascular fitness, which is critical for reducing long-term cardiovascular disease risk in individuals with intellectual and developmental disabilities [22]. Additionally, engaging in aerobic activity is associated with improvements in cognitive domains such as attention and processing speed [23].
To better understand the complex factors influencing PA engagement among adults with intellectual and developmental disabilities, behavior change frameworks may offer a useful lens for examining how fitness programs are designed and delivered. The Capability, Opportunity, Motivation-Behavior (COM-B) framework suggests that behavior change happens through interactions of physical and psychological capability, social and environmental opportunity, and reflective and automatic motivation [24]. Within the context of fitness programming, fitness professionals can play a critical role in building clients’ capabilities, creating opportunities, and fostering motivation [19].
Facilitating regular and successful engagement in PA necessitates supporting individuals with intellectual and developmental disabilities in skill and knowledge building, providing opportunities for access and connection with others, and boosting their motivation [25,26]. Individuals with intellectual and developmental disabilities should also be given opportunities to participate in fitness programs offered in their communities [27]. For this to happen, fitness professionals need to be prepared and comfortable working with diverse clients, including those with disabilities. The purpose of the study is to (a) examine fitness performance outcomes for adults with intellectual and developmental disabilities enrolled in an exercise program in the community and (b) explore the fitness goals and instructional methods used in the exercise program. Researchers can use these results to investigate professional development and training models for fitness professionals to increase access to high-quality fitness experiences for adults with intellectual and developmental disabilities. Within this study, the following research questions are addressed:
  • How do fitness outcomes, such as strength and flexibility, differ before and after a twelve-month enrollment in a fitness program for adults with intellectual and developmental disabilities?
  • How does the fitness instructor determine and prioritize program goals?
  • What instructional practices does the fitness instructor implement that can potentially influence the capability, opportunity, and motivation of adult clients with intellectual and developmental disabilities?

2. Materials and Methods

An explanatory sequential mixed methods design was used to understand the influence of regular PA engagement in adults with intellectual and developmental disabilities and to examine possible ‘reasons’ for those outcomes by qualitatively reviewing an existing fitness program for adults with intellectual and developmental disabilities. The study design included two distinct phases: (1) a quantitative phase that examined fitness outcomes for adults with intellectual and developmental disabilities that were engaged in a physical fitness program; and (2) a qualitative phase that explored the program itself as well as the instructional approaches used by the program’s instructor [28]. Using this design, quantitative data were analyzed first and qualitative data were then collected and analyzed to explain and elaborate on the quantitative results [29]. As one of the most widely used mixed methods designs, the primary intent of the sequential explanatory design was to use a qualitative strand to explain and interpret initial quantitative results [30]. Further, this design allowed for the qualitative results to provide context for significant (or non-significant) results, possible positive or negative outliers, or unanticipated results [31,32,33]. This study was approved in October 2019 by the second author’s University Institutional Review Board (IRB-19-536).

2.1. Setting and Participants

Phase one involved secondary analysis of a deidentified dataset from adults with intellectual and developmental disabilities engaged in an adapted fitness program in the southern United States. This fitness program was affiliated with a full-day educational program for young adults with cognitive disabilities and had been providing services for approximately five years prior to the commencement of the present study. Adults in the fitness program had to be enrolled in the affiliated educational program. A convenience data sample of 31 adults with intellectual and developmental disabilities who had participated in the fitness program for a minimum of one year were included in phase one. The dataset included 22 White, 6 Hispanic, and 3 Black adults with intellectual and developmental disabilities. The reported gender in the dataset included 16 females and 15 males, with ages ranging from 18 to 58, with a mean of 34.2 years. On average, adults with intellectual and developmental disabilities in the dataset had been involved in the fitness program for 2.5 years (range 1–5 years).
During phase two, fitness classes were observed, and the fitness instructor (n = 1) participated in two semi-structured interviews. The research team observed fitness classes on six different occasions, varying day of week and time of day. Following these observations, the fitness instructor was asked to participate in two separate semi-structured interviews. The first interview explored possible connections between quantitative results and initial findings from the field observations. The second interview generated further follow-up on ‘how’ and ‘why’ the instructor engaged in certain practices. All data were transcribed verbatim by a doctoral student and confirmed by the first and second authors. All direct quotes have been deidentified to protect participant confidentiality and are accompanied by a pseudonym chosen by the research team. The fitness instructor, James, was a 32-year-old Black male with more than ten years of experience providing fitness instruction to youth and adults with and without disabilities. He has formal education as an educator and was an elementary teacher and coach before changing professions to focus on fitness instruction for adults with disabilities. Refer to Table 1 for an overview of participant characteristics.

2.2. Phase One

2.2.1. Quantitative Data Collection

In this phase, a longitudinal dataset of fitness performance data from adults with intellectual and developmental disabilities was retrospectively analyzed to examine the potential impact of an adapted fitness program on health outcomes. The following fitness variables were collected at two different time points approximately one year apart: (a) flexibility test, (b) pushup test, (c) situp test, and (d) balance test. Additionally, the following anthropometric data were collected simultaneously with the fitness data: body mass index (BMI). Additional demographic information was collected that included: (a) age, (b) biological sex, (c) disability classification, and (d) type of fitness class attended (e.g., group or one-on-one). The same procedures were reported for both pre- and post-test measurements. This included the same scale being used for weight measurements, the same baseline sit and reach box trunk flexibility tester being used for the flexibility test, and participants completing pushups and situps at the post-test in the same manner they did for the pre-test (e.g., if they did modified pushups on their knees, they did modified pushups on their knees at the post measure). The balance test was a single-leg stance static balance test.

2.2.2. Data Analysis

Assumptions for paired-sample t-test were not met; therefore, the Wilcoxon signed rank nonparametric test was used to compare pairs. The normality of differences, checked using Shapiro–Wilk, was not met. The Wilcoxon signed rank test examines whether the difference between observations has a mean signed rank of 0. The Wilcoxon is more robust when outliers are present and when there are heavy tail distributions [34].

2.2.3. Data Integration

Following quantitative data analysis, the research team reviewed the significant and non-significant results, expected or unexpected outcomes, as well as potential visual differences among various sub-groups (e.g., age, gender, type of disability, and class setting). Through these discussions, the research team identified focal elements for phase two and guided the development of the field observation protocol and the preliminary interview guide.

2.3. Phase Two

2.3.1. Qualitative Data Collection

As mentioned, field observations of fitness classes and semi-structured interviews with the fitness instructor were conducted to offer insight into quantitative findings as well as explore the overall goals of the fitness program and instruction approaches used that may have contributed to those outcomes. Quantitative results were used to form specific questions posed to James, and they guided researchers during field observations. Originally, the research team planned to interview clients enrolled in the adapted fitness class; yet, due to the initial unknowns of COVID-19 in 2020, these interviews were not included as a part of the present analysis. However, they were interviewed at a later date, and results of that study can be found here [17].
Field Observations
Field observations were video recorded to capture instructor details in the fitness classes. These observations were completed across six different fitness classes. Each observation lasted sixty minutes. Two independent team members observed fitness classes and collected field notes for each observation. The lead author also video recorded each class. Video recordings were used to supplement field notes gathered by each independent reviewer.
Semi-Structured Interviews
The semi-structured interview guide was organized across three major topics, including: (1) job position; (2) professional development; and (3) teaching/instructional practices. The protocol explored James’s job responsibilities, program goals, training opportunities for professional growth, and instructional practices that may influence client capability, opportunity, and motivation to engage in exercise. The COM-B model for behavior change [24] was used to help describe capability (C), opportunity (O), and motivation (M) in PA engagement but was not used as an analytic tool. The preliminary interview guides were sent to five experts with qualitative research experience in adapted physical education, exercise science, and individuals with intellectual and developmental disabilities. Expert feedback was incorporated when finalizing the first and second interview guides. The final interview guides included 24 questions with several follow-up questions used as needed to support fitness instructor responses.

2.3.2. Data Analysis

A reflexive thematic analysis following Braun and Clark’s [35] six-phase process was used to guide data analysis. These six phases include: (1) data familiarization; (2) generating initial codes; (3) searching for themes; (4) reviewing themes; (5) defining and naming themes; and (6) producing reports. Data were imported into MAXQDA (MAXQDA version 24 by VERBI Software) [36] to aid in data coding and analysis. The first and second authors immersed themselves in the data by reviewing the field notes and interview transcripts twice. Next, data sources were iteratively coded, with codes developed or discarded as coding continued. For research question three, the research team mapped preliminary codes onto the COM-B model. At the end, examples were selected that accurately represented the generated themes and that also related to the research questions and the literature. Differences in coding were settled through discussion between research team members until a consensus was reached.

2.4. Research Team Positionality

All research team members were invested in research that facilitates positive social and health outcomes for young adults with intellectual and developmental disabilities. The first two authors have research interests and experience working in each other’s respective fields. The first author is an assistant professor in Special Education who has experience engaging in research developing and implementing exercise programs for adults with intellectual and developmental disabilities, as well as experience in qualitative and quantitative methodologies. The second author is an associate professor of kinesiology whose research focuses on PA behaviors and motor skill development across the lifespan of individuals with developmental disabilities. The third author is a doctoral student in Special Education who has experience in social skill instruction and applied behavior analysis. All authors have published similar research on fitness programming, instructional methods, the COM-B framework, and adults with intellectual and developmental disabilities.
In this study, while objective measures documented measurable change, field observations and interviews explained how and why outcomes occurred. Both observable outcomes and constructed lived experiences represent valid forms of knowledge, with contextual interpretation essential to understanding program impact. The authors established an approach to support integrity through ongoing dialogue, explicitly acknowledging and examining potential biases that might influence analysis and interpretation.

2.5. Credibility and Trustworthiness

To enhance the credibility and trustworthiness of the findings, several strategies were employed throughout data collection and analysis [37]. First, multiple observers were present during field observations, and each independently recorded detailed field notes. Second, a collaborative and iterative approach was used when coding field observations and interviews to help limit bias and explore multiple and alternative explanations of the interpreted data. Third, all interviews were transcribed verbatim to preserve authenticity of the participant’s responses and confirmed using video or audio recordings. Transcripts were then returned to the fitness instructor for member checking to ensure that transcripts accurately reflected their perspectives and experiences. No transcript changes were needed.

3. Results

The results are presented in two parts: (a) fitness performance outcomes (research question one) and (b) themes related to program goal development and instructional strategies used to support client progress and engagement in the fitness program (research questions two and three). Figure 1 provides an overview of the results for phase one, phase two, and the integration of the findings.

3.1. Fitness Performance Outcomes

A statistically significant reduction in body mass index (BMI) was observed from pre-program (M = 32.28, Mdn = 29.82) to post-program (M = 31.27, Mdn = 29.65, z = −3.137, p = 0.002). No statistically significant changes were found for other fitness measures. In examining mean score changes from pre- to post-program, flexibility scores showed a slight, although non-meaningful, decline (pre: M = 8.04, Mdn = 8.63; post: M = 7.80, Mdn = 8.25, z = 0.363, p = 0.717). Push-up performance showed a small increase in the mean (pre: M = 18.52, Mdn = 17; post: M = 18.86, Mdn = 15) but was not statistically significant (z = −0.930, p = 0.926). Sit-up scores increased from pre- (M = 11.12, Mdn = 9.5) to post-measurement (M = 13.95, Mdn = 14), yet this difference was also not significant (z = 0.711, p = 0.477). Lastly, statistically insignificant improvements in one-leg balance were observed for both right foot (pre: M = 2.37 sec, Mdn = 2.0; post: M = 4.63 sec, Mdn = 2.0; z = 1.505, p = 0.132) and left foot (pre: M = 3.11 sec, Mdn = 2.0; post: M = 5.42 sec, Mdn = 3.0; z = 1.582, p = 0.114).

3.2. Program Goals and Instructional Strategies

Five core themes emerged from the data: (1) personalized goal setting; (2) progressive challenge; (3) safe and flexible environments; (4) connection and belonging; and (5) celebration of progress and effort. These themes were consistently observed across each field observation and were supported by responses during the conducted interviews. Personalized goal setting was evident in both individual and group contexts, with clients identifying their own goals and, at times, collaborating to support peers in achieving theirs. The instructor facilitated this by promoting reflection and emphasizing client choice. Progressive challenge was embedded into the instructional strategies as the instructor gradually built skills and knowledge through scaffolded exercises, fading support, and consistent encouragement. The instructor also created safe and flexible environments. Fitness routines were structured, and physical structures were continually adapted to reduce barriers and support autonomy. Connection and belonging emerged as a recurring theme as there were ample opportunities to build trust, social relationships, and peer interaction that appeared to additionally generate excitement and encourage continued participation. Finally, celebration of progress and effort was a visible and consistent part of each session conducted by the instructor. James consistently acknowledged client successes, big and small, across each session and within most individual interactions with clients. The following sections expand on each of these themes as they related to research questions two and three.

3.2.1. Fitness Program Goals

Field observations and interviews with the fitness instructor, James, revealed that the fitness program emphasized individualized goal setting tailored to client interests and needs. Clients identified short- and long-term goals, ranging from weight loss to increased strength to increased time spent in social situations. James shared that he made sure his clients chose their own goals and worked with them to incorporate PA into those goals. For example, James shared:
A lot of our clients say things like, ‘I want to go to college’, or ‘I want to do all these things’, and if they express that, then I see it as my job to do everything I can to help make it happen. One of our guys said the other day, ‘I want to become a wrestler.’ And I thought, who am I to say no to that? If that’s what he wants, then okay, let’s start lifting weights. I’ll start treating this like you’re training to be a wrestler. Cool, let’s go. Honestly, when someone tells me I can’t do something, it just fuels me even more. That’s when I go 150%.
James often prompted reflective thinking (e.g., “why are these goals important to you?”) and started fitness sessions with goal planning activities. Participants were observed either writing down their personal goals on a planning sheet or sharing them verbally with James. After establishing a goal, each client was asked to identify two specific actions they could take to work toward that goal. James shared that many participants led sedentary lives and often avoided movement due to pain, lack of knowledge, and low expectations and that he wanted to help them build confidence in themselves and pick goals they wanted to achieve. James shared, “convincing somebody that they can do something when all their life they’ve been told they can’t, that’s the goal”.
Clients were guided by James to recognize obstacles (e.g., physical, psychological, and environmental) and talk through them. During one session, James related the idea of obstacle courses to life barriers, drawing connection between physical exertion and real-world challenges. James shared “training is also education…our guys and ladies being able to handle adversity, that’s growth”. James consistently encouraged gradual exposure to challenge. In one case, a client refused to leave the van who had an initial goal of entering the gym but later became one of the most engaged clients. James incorporated interests and community and celebrated client success as they achieved goals and small steps along the way.

3.2.2. Instructional Strategies

James used and described several instructional methods, including how he learned to use various strategies. The strategies described below are broken down into the following categories: (a) strategies that promoted physical and psychological skills in clients; (b) strategies that fostered opportunities, both physical/environmental and social, for clients; and (c) strategies that intended to motivate clients to reach their individualized fitness program goals. James frequently checked for understanding, modeled exercises and safe equipment use, gave prompts, provided feedback, incorporated client choice, and taught self-management strategies, such as goal setting and attainment. James also provided insight into the training he received and past experiences that supported how he determined what instructional strategies to use. See Table 2 for illustrative examples of these identified themes, along with alignment to the COM-B framework.
Strategies Promoting Capability
James implemented and discussed several strategies that facilitated potential skill acquisition and knowledge, including using plain language during instructions, demonstrations, feedback, physical guidance, and checks for understanding. Plain language examples included renaming exercises, such as describing a squat jump as a “get up with a jump”. He frequently demonstrated strategies that supported physical skill growth as well as an increase in knowledge for clients. James shared, “I can say do a burpee all day, but if I don’t show them, those words don’t mean anything”. He consistently followed that demonstration with an opportunity for clients to ask questions. Exercises were progressively introduced and adapted to the client level. For example, wall pushups were used within an exercise routine that progressed to modified pushups on the floor.
During exercises, James provided ongoing feedback and physical support. For example, he was observed correcting client form while they were on a rowing machine while simultaneously describing why form was important for injury prevention. James often encouraged clients to engage in exercises that were new and challenging but provided encouragement and support in those situations. On the occasions he was observed providing physical support for skills, he asked clients for permission to touch them before the exercise. He often used graduated guidance during exercises using machines, which included hovering nearby and being ready to support the client with the level of prompting needed to safely perform the exercise.
When asked about his background and how he learned to use the strategies he selects, he mentioned starting his education with the goal of being a kindergarten teacher but that he always had a passion for kids and sports. For example, James shared:
Um, the fitness world has always really just been my comfort zone. The teaching route, like I said, I was really excited about it. Of course, I’ll be completely honest, I just did not necessarily like, what the school systems were doing. And so I was like, well, I’d rather teach and instruct and pass on what I know, as far as the fitness world I can control. And that’s kind of fitness gives you the freedom to not only just obviously exercise, but then you can really, really teach kind of how you want to kind of follow your own mold and following your own path. And, um, you know, you know, that kind of thing. So, it just gave me a lot of freedom, and which I really did not see in the school system, unfortunately. So not to knock any teachers not to knock any school systems and any ISDs or anything like that. Just it just wasn’t a good fit for me.
When discussing disability specifically, James talked about his experience with his niece who has disabilities. He learned strategies to communicate with her over time and noticed that she did best when he demonstrated things he wanted her to do. James discussed a need for more specific training on working with clients with more extensive support needs, especially those who are exercising that have a disability and medical condition or have challenging behaviors that need de-escalation support. He said that the company he works for has a program for adults with intellectual and developmental disabilities, which helped him to grow. They hold training sessions related to challenging behavior and medical management. “I would not have that if I was just an independent fitness instructor or working for a gym”.
Strategies Promoting Opportunity
Several strategies were observed and discussed that supported both environmental and social opportunities for clients. James provided multiple opportunities for the clients to move and engage in diverse contexts. He exposed clients to various equipment and asked clients to complete exercises in indoor and outdoor spaces, with and without equipment, and used both individual and partnered activities. During each observation, the physical space was laid out differently (e.g., he had the rowing machines out for one session but not another). However, the sessions always followed a predictable routine. They discussed goals, warmed up, completed stations, and ended with a game-based exercise (e.g., baseball fitness). During the last observation they moved to a new fitness center space for class. James gave them all a tour of the new equipment, provided opportunities to ask questions, checked for understanding, and provided warnings about potential dangers of some equipment. During the field observation, James stated, “this is our new gym, please respect the gym. Tell me what this machine is…before we get started does anybody have a question?”
James used humor, individualized connections with clients (e.g., remembering their birthdays), and strategic pairing of clients. James shared, “once they know you care and trust you, that’s when you can reach them”. James shared personal narratives of dealing with discrimination and low expectations, aligning himself with similar experiences of clients with intellectual and developmental disabilities. “They’ve been told their whole life they can’t, I’ve been there. I get it”. During each class, James provided intentional opportunities for clients to partner together for exercises. These partnership activities often resulted in clients having conversations with one another, from talking about the exercises to favorite sports teams. The clients supported and encouraged each other when partnered up as well (e.g., aiding one another on exercise machines and initiating high fives).
Strategies Promoting Motivation
James demonstrated and discussed several strategies he used to potentially motivate clients. He provided choice, turned challenging activities into games, provided encouragement, and celebrated achievements, all while having high expectations. Clients were observed voting on exercises or choosing their own activity or music they wanted to listen to while engaging in exercise sessions. One client shouted “Yeah!” when James asked what song they wanted and picked the song this client shouted out. James was observed engaging clients in activities like fitness baseball, which encouraged various movements and harder exercises while playing a game and encouraged skills around being a good teammate among the two groups playing each other.
During an observation, James shouted, “we’re going to do something crazy today, but it’s got a hidden purpose”. While the trainer expected a lot from the clients, he was observed balancing that rigor with humor and positive reinforcement. During several observations and during interviews, he discussed looking for any opportunity to celebrate achievements, big or small. “I probably have the highest expectations of really anybody, but I keep it fun”. The field observations consistently showed James celebrating achievements, from completing a single rep to finishing an entire circuit. Clients were seen laughing, showing each other their sweaty shirts, or repeating victories, like tagging James during games like fitness baseball.

4. Discussion

The purpose of this mixed methods study was to examine the fitness performance outcomes for adults with intellectual and developmental disabilities enrolled in an adapted exercise program and explore the program’s goals and instructional strategies that might offer insight into those outcomes. While there was a significant reduction in BMI after 12 months of program participation, other fitness measures, such as balance, flexibility, and strength, did not change significantly. The qualitative findings enriched the interpretation of these results by highlighting individualized goals and instructional methods that may have contributed to maintenance and engagement. Without the integration of the qualitative data, the insignificant results of most measures might infer a minimal impact from the fitness program. However, through integrating and interpreting both quantitative and qualitative data, a more holistic inference can be made about the possible benefits for individuals with intellectual and developmental disabilities participating in adapted fitness courses, including how ‘success’ might be measured or which practices should be replicated. Resultantly, these findings suggest that: (1) more than quantitative data is needed to judge the impacts of adapted fitness programs for adults with intellectual and developmental disabilities, and (2) the instructor must be skillful and maintain flexibility to meet the varying needs of adults with intellectual and developmental disabilities.

4.1. Fitness Outcomes and Program Goals

The significant reduction in BMI suggests that long-term participation in a structured fitness program may help adults with intellectual and developmental disabilities to manage weight, which is a key health-related goal given the high prevalence of obesity and related comorbidities in this population [38]. Although other outcomes, such as balance, flexibility, and strength, did not have significant improvements, the fitness outcomes were maintained or showed slight improvement. The absence of statistically significant change may be attributed, in part, to the instructor’s intentional use of individualized client-driven goals to guide programming decisions. During field observations, clients stated a range of personal goals, some of which included increasing range of motion, increasing time spent with same-aged peers, and weight loss. As a result, the programming was tailored to support these individualized goals, which may have contributed to variability in the measured fitness outcomes. Prior research suggests that individualized goals are associated with increased engagement and positive program experiences [39]. Although not preferable, the lack of change may prove to be a net positive considering that, although individuals did not improve in strength or balance, they also did not regress (i.e., lose strength or balance). Maintaining one’s health as individuals get older is vital to combat many of the negative side effects of aging [40]. These findings align with prior research indicating that, while physical changes may take time or require more intensive intervention, consistent participation can promote gradual improvements or maintenance in health-related fitness [17,18]. Furthermore, the broader benefits of engagement in exercise programs, including social connection, belonging, and improved self-efficacy, should not be overlooked, even when fitness outcomes improve slowly [20].

4.2. Instructional Approaches

The qualitative phase provided insight into how instructional strategies can enhance the capability, opportunity, and motivation of adults with intellectual and developmental disabilities to engage in PA, which may have contributed to the impact on BMI and skill maintenance inferred from the quantitative data. Five key themes, including personalized goal setting, progressive challenge, safe and flexible environments, connection and belonging, and celebration of progress, emerged. The instructor’s emphasis on client-centered goal setting and individual agency created a foundation for engagement and skill acquisition [41]. This strategy likely contributed to clients’ increased confidence and ownership over their progress, which is especially critical for populations that have historically experienced low expectations or exclusion from fitness spaces [15]. Moreover, the use of motivational strategies, such as incorporating client choice, infusing fun into sessions, and celebrating small achievements, appeared to help foster a sense of belonging and enjoyment, like in previous research (e.g., [14,42]). Additionally, James’s ability to adapt exercises in the moment, demonstrate exercises and provide meaningful feedback, and build rapport through humor and empathy likely helped to remove many physical, psychological, and social barriers to exercise experienced by adults with intellectual and developmental disabilities [11,14]. Like previous research [42], the environment, including instructor demonstrations and client support for each other, appears to be particularly important for countering typical barriers to PA and poor prior experiences.

4.3. Implications for Practice

The findings from this study have important implications for both fitness programming and professional development. First, these findings reinforce the need for fitness professionals to receive training in adapting exercises and communication strategies for clients with intellectual and developmental disabilities. Second, this study highlights the value of building inclusive relational fitness environments where social connection, client autonomy, and gradual skill development are prioritized alongside physical outcomes.
Training programs that embed frameworks such as COM-B and incorporate hands-on experience with diverse clients may better equip professionals to deliver accessible high-quality fitness experiences. Community-based organizations and fitness centers can use these findings to enhance program design, promote long-term participation and feelings of belonging, and ensure that clients with intellectual and developmental disabilities experience benefits associated with PA.

4.4. Limitations and Future Research Directions

Several limitations should be discussed. The small sample size and use of secondary fitness data limit the generalizability of the quantitative findings. Additionally, measurement variability and the presence of outliers may have influenced the ability to detect statistically significant changes. Related to data for adults with intellectual and developmental disabilities, diagnosis for inclusion in the quantitative dataset was determined by the vocational program inclusion criteria and not confirmed separately by our research team. While the instructor provided rich insights, perspectives from additional clients directly were not included within this specific study design. However, client perspectives from this same program were collected, analyzed, and published in a separate manuscript [19]. Finally, this study focused on a single fitness program, so replication across diverse settings and instructors is needed for broader applicability.
Future research should continue to explore how specific instructional strategies influence sustained engagement and health outcomes for adults with intellectual and developmental disabilities, particularly within inclusive or community-based settings. Longitudinal studies with larger samples and more diverse demographics would strengthen the evidence. In addition, studies that incorporate the voices of participants with intellectual and developmental disabilities are critical for understanding how they perceive fitness, barriers, and facilitators [43]. Research focused on developing and evaluating training models for fitness professionals could further inform efforts to build inclusive fitness communities.

5. Conclusions

The findings from this study indicate that an adapted fitness program can support meaningful health outcomes for adults with intellectual and developmental disabilities, including decreased BMI and maintenance of other fitness measures over time. The field observations and interviews highlighted instructional strategies such as personalized goal setting, progressive challenge, and supportive flexible environments that supported PA engagement. This study also emphasized the importance of preparing fitness professionals to work effectively with adults with intellectual and developmental disabilities through targeted training. Overall, well-designed fitness programs may enhance long-term physical, social, and cognitive well-being for adults with intellectual and developmental disabilities even if significant changes are not witnessed by quantitative measures alone.

Author Contributions

Conceptualization, M.N.S. and A.M.C.-D.; methodology, M.N.S. and A.M.C.-D.; formal analysis, M.N.S. and A.M.C.-D.; investigation, M.N.S. and A.M.C.-D.; writing—original draft preparation, M.N.S., A.M.C.-D. and F.K.; writing—review and editing, M.N.S. and F.K.; funding acquisition, M.N.S. and A.M.C.-D. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by the University of North Texas, College of Education, Collaborative Grant Competition.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of the University of North Texas (IRB-19-536, 19 October 2019).

Informed Consent Statement

Informed consent was obtained from all participants involved in the study.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author, M.N.S., upon reasonable request. The data are not publicly available due to privacy and ethical restrictions.

Acknowledgments

We acknowledge the support from students Mehri Mirzaeirafe and Ana West during data collection and transcript cleaning.

Conflicts of Interest

The authors declare no conflicts of interest.

Disability Language/Terminology Positionality Statement

In this manuscript, we adopted person-first language (e.g., “adults with intellectual and developmental disabilities”). This choice reflects a commitment to emphasizing the individuality of students before their disability, in accordance with inclusive education policies and legal frameworks that prioritize equity and participation. We recognize that disability language preferences vary across communities and individuals.

Abbreviations

The following abbreviations are used in this manuscript:
BMIBody Mass Index
COM-BCapability, Opportunity, Motivation-Behavior

References

  1. Physical Activity Guidelines Advisory Committee. 2018 Physical Activity Guidelines Advisory Committee Scientific Report; US Department of Health and Human Services: Rockville, MD, USA, 2018.
  2. Dairo, Y.M.; Collett, J.; Dawes, H.; Oskrochi, G.R. Physical activity levels in adults with intellectual disabilities: A systematic review. Prev. Med. Rep. 2016, 4, 209–219. [Google Scholar] [CrossRef] [PubMed]
  3. Stancliffe, R.J.; Anderson, L.L. Factors associated with meeting physical activity guidelines by adults with intellectual and developmental disabilities. Res. Dev. Disabil. 2017, 62, 1–14. [Google Scholar] [CrossRef] [PubMed]
  4. Oppewal, A.; Hilgenkamp, T.I.; Van Wijck, R.; Evenhuis, H.M. Cardiorespiratory fitness in individuals with intellectual disabilities: A review. Res. Dev. Disabil. 2013, 34, 3301–3316. [Google Scholar] [CrossRef]
  5. Graham, A.; Reid, G. Physical fitness of adults with an intellectual disability: A 13-year follow-up study. Res. Q. Exerc. Sport 2000, 71, 152–161. [Google Scholar] [CrossRef]
  6. Zghal, F.; Borji, R.; Colson, S.S.; Sahli, S.; Rebai, H. Neuromuscular characteristics in trained vs. sedentary male adults with intellectual disability. J. Intellect. Disabil. Res. 2019, 63, 1334–1345. [Google Scholar] [CrossRef] [PubMed]
  7. Bergström, H.; Hagströmer, M.; Hagberg, J.; Elinder, L.S. A multi-component universal intervention to improve diet and physical activity among adults with intellectual disabilities in community residences: A cluster randomised controlled trial. Res. Dev. Disabil. 2013, 34, 3847–3857. [Google Scholar] [CrossRef]
  8. Hildebrandt, V.H.; Chorus, A.M.J.; Stubbe, J.H. Trend Report on Physical Activity and Health 2008/2009; TNO Innovation for Life: Leiden, The Netherlands, 2010. [Google Scholar]
  9. Lynch, L.; McCarron, M.; Eustace-Cook, J.; Burke, É.; McCallion, P. Physical health effects of sedentary behaviour on adults with an intellectual disability: A scoping review. J. Intellect. Disabil. 2025, 29, 167–193. [Google Scholar] [CrossRef] [PubMed]
  10. Sutherland, G.; Couch, M.A.; Iacono, T. Health issues for adults with developmental disability. Res. Dev. Disabil. 2002, 23, 422–445. [Google Scholar] [CrossRef] [PubMed]
  11. Bossink, L.W.; van der Putten, A.A.; Vlaskamp, C. Understanding low levels of physical activity in people with intellectual disabilities: A systematic review to identify barriers and facilitators. Res. Dev. Disabil. 2017, 68, 95–110. [Google Scholar] [CrossRef] [PubMed]
  12. Eisenberg, Y.; Vanderbom, K.A.; Vasudevan, V. Does the built environment moderate the relationship between having a disability and lower levels of physical activity? A systematic review. Prev. Med. 2017, 95, S75–S84. [Google Scholar] [CrossRef]
  13. Dixon-Ibarra, A.; Nery-Hurwit, M.; Driver, S.; MacDonald, M. Using health promotion guidelines for persons with disabilities to develop and evaluate a physical activity program for individuals with multiple sclerosis: A feasibility study. Eval. Program Plan. 2017, 61, 150–159. [Google Scholar] [CrossRef] [PubMed]
  14. Martin, J.J. Benefits and barriers to physical activity for individuals with disabilities: A social-relational model of disability perspective. Disabil. Rehabil. 2013, 35, 2030–2037. [Google Scholar] [CrossRef] [PubMed]
  15. Calder, A.; Sole, G.; Mulligan, H. The accessibility of fitness centers for people with disabilities: A systematic review. Disabil. Health J. 2018, 11, 525–536. [Google Scholar] [CrossRef] [PubMed]
  16. Boer, P.H.; Meeus, M.; Terblanche, E.; Rombaut, L.; Wandele, I.D.; Hermans, L.; Gysel, T.; Ruige, J.; Calders, P. The influence of sprint interval training on body composition, physical and metabolic fitness in adolescents and young adults with ID: A randomized controlled trial. Clin. Rehabil. 2014, 28, 221–231. [Google Scholar] [CrossRef] [PubMed]
  17. Lotan, M.; Yalon-Chamovitz, S.; Weiss, P.L.T. Improving physical fitness of individuals with intellectual and developmental disability through a virtual reality intervention program. Res. Dev. Disabil. 2009, 30, 229–239. [Google Scholar] [CrossRef] [PubMed]
  18. Shields, N.; Taylor, N.F.; Wee, E.; Wollersheim, D.; O’Shea, S.D.; Fernhall, B. A community-based strength training programme increases muscle strength and physical activity in young people with Down syndrome: A randomised controlled trial. Res. Dev. Disabil. 2013, 34, 4385–4394. [Google Scholar] [CrossRef]
  19. Savage, M.N.; Colombo-Dougovito, A.M. Capabilities, opportunities, and motivation: Exploring fitness program experiences of adults with intellectual and developmental disabilities. Int. J. Environ. Res. Public Health 2023, 20, 5771. [Google Scholar] [CrossRef]
  20. Bartlo, P.; Klein, P.J. Physical activity benefits and needs in adults with intellectual disabilities: Systematic review of the literature. Am. J. Intellect. Dev. Disabil. 2011, 116, 220–232. [Google Scholar] [CrossRef] [PubMed]
  21. Obrusnikova, I.; Firkin, C.J.; Cavalier, A.R.; Suminski, R.R. Effects of resistance training interventions on muscular strength in adults with intellectual disability: A systematic review and meta-analysis. Disabil. Rehabil. 2022, 44, 4549–4562. [Google Scholar]
  22. Bouzas, S.; Martínez-Lemos, R.I.; Ayán, C. Effects of exercise on the physical fitness level of adults with intellectual disability: A systematic review. Disabil. Rehabil. 2019, 41, 3118–3140. [Google Scholar] [CrossRef] [PubMed]
  23. Chueh, T.Y.; Wu, J.H.; Hung, W.K.; Pan, C.C.; Chou, C.C.; Huang, C.J.; Wu, C.T. The effects of single bouts of physical activity on cognition in adolescents and young adults with intellectual disabilities: A systematic review. J. Appl. Res. Intellect. Disabil. 2025, 38, e70026. [Google Scholar] [CrossRef]
  24. Michie, S.; Van Stralen, M.M.; West, R. The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implement. Sci. 2011, 6, 42. [Google Scholar] [CrossRef]
  25. Mahy, J.; Shields, N.; Taylor, N.F.; Dodd, K.J. Identifying facilitators and barriers to physical activity for adults with down syndrome. J. Intellect. Disabil. Res. 2010, 54, 795–805. [Google Scholar] [CrossRef] [PubMed]
  26. West, R.; Michie, S. A brief introduction to the COM-B Model of behaviour and the PRIME Theory of motivation [v1]. Qeios 2020, 2. [Google Scholar] [CrossRef]
  27. Rimmer, J.H.; Braddock, D. Health promotion for people with physical, cognitive, and sensory disabilities: An emerging national priority. Am. J. Health Promot. 2002, 16, 220–224. [Google Scholar] [CrossRef] [PubMed]
  28. Creswell, J.W.; Plano Clark, V.L.; Gutmann, M.; Hanson, W. Advanced mixed methods research designs. In Handbook on Mixed Methods in the Behavioral and Social Sciences; Tashakkori, A., Teddlie, C., Eds.; Sage: Thousand Oaks, CA, USA, 2003; pp. 209–240. [Google Scholar]
  29. Ivankova, N.V.; Creswell, J.W.; Stick, S.L. Using mixed-methods sequential explanatory design: From theory to practice. Field Methods 2006, 18, 3–20. [Google Scholar] [CrossRef]
  30. Creswell, J.W.; Plano Clark, V.L. Designing and Conducting Mixed Methods Research, 3rd ed.; SAGE Publications: Thousand Oaks, CA, USA, 2017. [Google Scholar]
  31. Bradley, E.H.; Curry, L.A.; Ramanadhan, S.; Rowe, L.; Nembhard, I.M.; Krumholz, H.M. Research in action: Using positive deviance to improve quality of health care. Implement. Sci. 2009, 4, 25. [Google Scholar] [CrossRef]
  32. Morgan, D.L. Integrating Qualitative and Quantitative Methods: A Pragmatic Approach; Sage: Thousand Oaks, CA, USA, 2014. [Google Scholar]
  33. Morse, J.M. Approaches to qualitative-quantitative methodological triangulation. Nurs. Res. 1991, 40, 120–123. [Google Scholar] [CrossRef] [PubMed]
  34. Divine, G.; Norton, H.J.; Hunt, R.; Dienemann, J. A review of analysis and sample size calculation considerations for Wilcoxon tests. Anesth. Analg. 2013, 117, 699–710. [Google Scholar] [CrossRef] [PubMed]
  35. Braun, V.; Clarke, V. Using thematic analysis in psychology. Qual. Res. Psychol. 2006, 3, 77–101. [Google Scholar] [CrossRef]
  36. VERBI Software. MAXQDA, version 24; VERBI Software: Berlin, Germany, 2025. Available online: https://www.maxqda.com (accessed on 1 February 2025).
  37. Levitt, H.M.; Motulsky, S.L.; Wertz, F.J.; Morrow, S.L.; Ponterotto, J.G. Recommendations for designing and reviewing qualitative research in psychology: Promoting methodological integrity. Qual. Psychol. 2017, 4, 2–22. [Google Scholar] [CrossRef]
  38. Ryan, J.; McCallion, P.; McCarron, M.; Luus, R.; Burke, E.A. Overweight/obesity and chronic health conditions in older people with intellectual disability in Ireland. J. Intellect. Disabil. Res. 2021, 65, 1097–1109. [Google Scholar] [CrossRef] [PubMed]
  39. Perkoski, V.; Shotwell, M.; Chatto, C.; Chandler, J. Pushing forward: Understanding physical activity in adults with medical complexity. Health Care Transit. 2025, 3, 100102. [Google Scholar] [CrossRef]
  40. Hassan, N.M.; Landorf, K.B.; Shields, N.; Munteanu, S.E. Effectiveness of interventions to increase physical activity in individuals with intellectual disabilities: A systematic review of randomised controlled trials. J. Intellect. Disabil. Res. 2019, 63, 168–191. [Google Scholar] [CrossRef] [PubMed]
  41. Carey, E.; Ryan, R.; Sheikhi, A.; Dore, L. Exercising autonomy: The effectiveness and meaningfulness of autonomy support interventions engaged by adults with intellectual disability. A mixed-methods review. Br. J. Learn. Disabil. 2023, 51, 307–323. [Google Scholar] [CrossRef]
  42. Michalsen, H.; Wangberg, S.C.; Anke, A.; Hartvigsen, G.; Jaccheri, L.; Arntzen, C. Family members and health care workers’ perspectives on motivational factors of participation in physical activity for people with intellectual disability: A qualitative study. J. Intellect. Disabil. Res. 2020, 64, 259–270. [Google Scholar] [CrossRef] [PubMed]
  43. Bodde, A.E.; Seo, D.C. A review of social and environmental barriers to physical activity for adults with intellectual disabilities. Disabil. Health J. 2009, 2, 57–66. [Google Scholar] [CrossRef] [PubMed]
Disabilities 06 00027 g001
Figure 1. Results overview: phase one, phase two, and integration.
Figure 1. Results overview: phase one, phase two, and integration.
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Table 1. Participant characteristics.
Table 1. Participant characteristics.
CharacteristicAdults with Intellectual and Developmental DisabilitiesFitness Instructor
Age (years)34.2 (range: 18–58)32
Gender
Female16 (52%)
Male15 (48%)1 (100%)
Race/ethnicity
African American3 (10%)1 (100%)
Caucasian22 (71%)
Hispanic6 (19%)
Years in fitness program2.5 (range: 1–5)
Instruction experience (years) 12
Table 2. Illustrative examples related to capability, opportunity, and motivation in fitness classes for adults with intellectual and developmental disabilities.
Table 2. Illustrative examples related to capability, opportunity, and motivation in fitness classes for adults with intellectual and developmental disabilities.
COM-B ComponentComponent DescriptionField Observation ExamplesField Observation: Illustrative Quotes Interview ExamplesInterview:
Illustrative Quotes
Physical capabilityPhysical skill, strength, stamina, and balanceClients were observed using exercise equipment, changing their exercise form when the instructor asked for change. Modifications used for some clients such as wall pushups to replace traditional pushups.Instructor: That’s almost it. Get down more.
Client #01: squats lower
Instructor: Perfect. Good job
Client #01: I got it.		Discussion on class type and how to work on client individual needs while teaching in large group.Instructor: So, let’s say (client) is really good with lower body strength but his upper body strength and cardio need work. That’s a goal for the group. So maybe do some front raises, superset with some squats. He is getting what he needs. So, everybody’s hitting on their weaknesses while some may be building on their strengths at the same time.
Psychological capabilityKnowledge or psychological skills (e.g., understanding and memory)After exercise descriptions and demonstration, the fitness instructor checked for understanding. Clients shook their heads or verbalized they understood or asked for further clarification.Instructor: Show me your pushup position.
Client #02: Like this?
Instructor: Yes, that looks good!		The instructor expanded on how to engage clients when doing the exercise and checking for understanding.Instructor: I’m a firm believer in is telling you what I want to do, letting it sink in, going over it two or three times, and then showing and then allowing people to ask questions, and then modeling again, while answering questions. Checking for comprehension as we go and then go in and modeling.
Environmental opportunityTime, finances, materials, and resources related to environmental systemThe fitness trainer provided opportunities to use new exercise machines. He described the exercise, modeled how to use the equipment, and demonstrated the exercise. When clients tried the exercise, he provided feedback and behavior-specific praise.Client#04: What’s this?
Instructor: This is called our leg extension and leg curl machine. [Instructor models exercise and how to change the weight on the machine].		The instructor explored the effectiveness of the program and opportunities throughout the program.Instructor: You’re meeting somebody where they are; nobody is the same.
If (client name) and (client name) both struggle with pushups, (client) might do them on the wall and (client) might do them on the ground but they’re still doing the movement so never making somebody feel less than for showing an inkling of different in what somebody else is doing because they are still achieving the goal.
Social opportunityInterpersonal influences, culture, and social normsThe instructor connected individually with clients.Instructor: Who remembers my favorite exercise with TRX?
Client #05: Squat!
Instructor: What is yours?		The instructor uses intentional pairings to help push clients to meet their goals. Instructor: You can see, when you pair people correctly, the person starting to nudge ahead the individuals, like a constant battle and I don’t know if they have any idea they’re doing it. But that’s how they grow, whether it be through competition, whether just seeing somebody else model, what you want to achieve, and I just love it.
Automatic motivationEmotional reactions, desires, drive, and impulses Instructor included choice regularly into fitness sessions.
Instructor: Let’s write down everyone’s activity choice for today.
Client #06: I want baseball today.
Client#08: Let’s do the obstacle course.
Instructor: What are we listening to today?
Client#04: NAS! (Old Town Road)		Instructor talked about fun environments motivating clients.Instructor: I just really believe that if you are having fun, no matter what kind of fun you’re having, you are more subjectable to learn in that type of environment versus other environments that you’re in.
Reflective motivationConscious plans and evaluations (beliefs about what is good and bad)The instructor began fitness classes with individualized goal setting. Clients got to choose their goals.Instructor: Going to talk about goal sheets before starting. What are your goals?
Client #03: Lift more weights
Client #04: Lose 60 pounds		The fitness instructor discussed beliefs that may have influenced exercise behaviors.Instructor: I probably going to say both. If you have CrossFit parents at home growing up your entire life, you’re probably going to be more prone to that.
I had a client who had goal that he didn’t want to stay in a wheelchair all the time. He is taking some PT sessions on a regular basis.
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Savage, M.N.; Colombo-Dougovito, A.M.; Kelly, F. A Mixed Methods Analysis of an Adapted Fitness Program for Adults with Intellectual and Developmental Disabilities. Disabilities 2026, 6, 27. https://doi.org/10.3390/disabilities6020027

AMA Style

Savage MN, Colombo-Dougovito AM, Kelly F. A Mixed Methods Analysis of an Adapted Fitness Program for Adults with Intellectual and Developmental Disabilities. Disabilities. 2026; 6(2):27. https://doi.org/10.3390/disabilities6020027

Chicago/Turabian Style

Savage, Melissa N., Andrew M. Colombo-Dougovito, and Farwa Kelly. 2026. "A Mixed Methods Analysis of an Adapted Fitness Program for Adults with Intellectual and Developmental Disabilities" Disabilities 6, no. 2: 27. https://doi.org/10.3390/disabilities6020027

APA Style

Savage, M. N., Colombo-Dougovito, A. M., & Kelly, F. (2026). A Mixed Methods Analysis of an Adapted Fitness Program for Adults with Intellectual and Developmental Disabilities. Disabilities, 6(2), 27. https://doi.org/10.3390/disabilities6020027

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