A community-based strength training programme increases muscle strength and physical activity in young people with Down syndrome: a randomised controlled trial

Fostering positive attitudes towards interacting with young people with disability among health students: a stepped-wedge trial

PURPOSE

To investigate if a 12-week community-based exercise program (FitSkills) fostered positive attitudes towards disability among university student mentors.

METHODS

A stepped-wedge cluster randomised trial was completed with 4 clusters. Students were eligible to be a mentor if enrolled in an entry-level health degree (any discipline, any year) at one of three universities. Each mentor was matched with a young person with a disability and the pair exercised together at the gym twice a week for an hour (24 sessions total). At 7 times over 18 months, mentors completed the Disability Discomfort Scale to indicate their level of discomfort when interacting with people with disability. Data were analysed according to the intention to treat principles using linear mixed-effects models to estimate changes in scores over time.

RESULTS

A total of 207 mentors completed the Disability Discomfort Scale at least once, of whom 123 participated in FitSkills. Analysis found an estimated reduction of 32.8% (95% confidence interval (CI) -36.8 to -28.4) in discomfort scores immediately after exposure to FitSkills across all four clusters. These decreases were sustained throughout the remainder of the trial.

CONCLUSIONS

Mentors reported more positive attitudes towards interacting with people with disability after completing FitSkills with changes retained for up to 15 months.

Functional fitness of adults with Down syndrome: a longitudinal study

BACKGROUND

Individuals with Down syndrome (DS) are born with and develop many health-related complications. The purpose of this study was to determine the longitudinal functional fitness profile of adults with DS.

METHODS

The functional fitness of adults with DS was tested twice, 12 years apart. Sixty-six adults with DS were tested for body mass, stature and 10 functional fitness tests. Data were categorised according to gender and age-specific categories.

RESULTS

Static balance, shoulder flexibility, trunk strength and aerobic capacity deteriorated significantly with medium to large effect sizes for both DS men and women (most age categories). For women, dynamic balance deteriorated significantly, and for men, leg- and upper body-strength deteriorated significantly.

CONCLUSIONS

Practitioners working in the field of adapted physical activity should take cognisance of the functional fitness ageing profile of adults with DS and timeously develop habitual physical activity interventions to reduce the effect of accelerated ageing experienced by this population.

Synergizing the Behavior Change Wheel and a Cocreative Approach to Design a Physical Activity Intervention for Adolescents and Young Adults With Intellectual Disabilities: Development Study

BACKGROUND

There is a need for physical activity promotion interventions in adolescents and young adults with intellectual disabilities. Current interventions have shown limited effectiveness, which may be attributed to the absence of theory and a population-specific development. Combining a planning model (including theory) and cocreation with the target audience during intervention development could potentially address this gap.

OBJECTIVE

This study aimed to report the systematic development of the Move it, Move ID! intervention by describing how the 8 different steps of the Behavior Change Wheel (BCW) were applied and present the results that emerged from those steps. In doing so, the (theoretical) content of the intervention is described in detail.

METHODS

A total of 23 adolescents and young adults (aged 14-22 years) with mild to moderate intellectual disabilities were designated as cocreators of the intervention. Across 2 groups, 6 similar cocreation sessions were organized in each. The content and sequence of the sessions were structured to align with the 8 steps of the BCW. All sessions were recorded and transcribed verbatim. Both a deductive (ie, steps of the BCW) and inductive (ie, resonating the voice of the participants) analysis approach were applied specifically focusing on identifying and describing the findings within each of the BCW steps.

RESULTS

After behavioral analysis (steps 1-4), 10 intervention goals were chosen and linked to Capability, Opportunity, and Motivation-Behavior components (theory within the BCW) that needed to be addressed. Psychological capability, social opportunity, and reflective motivation were emphasized as the first targets to focus on. A key finding was the urge for real-life social connectedness and social integration, which makes the social component as part of physical activity a central theme to focus on within intervention development. Judgments on the most suitable intervention functions (step 5) and behavior change techniques (step 7) were explained. When discussing the mode of delivery of the intervention (step 8), it was underscored that solely relying on a mobile health app would not fulfill participants' social needs. Hence, the chosen intervention adopts a dyadic approach in which young individuals with intellectual disabilities are matched with peers without intellectual disabilities to engage in physical activities together, with a mobile app playing a supportive role in this partnership.

CONCLUSIONS

The transparent description of the development process highlights why certain intervention components and behavior change techniques were chosen and how they are intertwined by means of the selected intervention design. This paper provides a detailed blueprint for practitioners wanting to integrate the BCW and its associated behavior change techniques, in combination with actively involving the target group, into their intervention development for people with intellectual disabilities.

Exploring the transformative power of dance: A scoping review of dance interventions for adults with intellectual disabilities

The aim of this scoping literature review (SCR) was to analyze the impact of dance on adults with intellectual disabilities, specifically examining its influence on their mobility, interpersonal relationships, well-being, and overall quality of life. A total of 15 papers were reviewed in order to explore the effects of dance on the well-being and quality of life of adults with intellectual disabilities. The findings indicated significant improvements in body awareness, increased engagement in physical activity, and enhanced mental health. This SCR demonstrates that dance is an effective means of facilitating social interaction among adults with intellectual disabilities, both with their therapists and family members. Additionally, the review uncovered valuable data on dance therapy programs designed for adults with intellectual disabilities, highlighting their potential to promote physical activity and reduce stress levels.

Effects of exercise programs on cardiovascular responses in individuals with down syndrome: A systematic review and meta-analysis

The purpose of this study is to conduct a systematic review and meta-analysis of exercise interventions designed to improve cardiovascular responses in individuals with DS. A search for relevant articles was conducted on seven electronic databases: PubMed, PEDro, Google Scholar, Scopus, WOS, MEDLINE, and SPORT Discus. An electronic search was conducted on October 15, 2022, without applying any year constraints. The studies were chosen based on a predetermined set of inclusion and exclusion criteria. The methodology of the study was evaluated using the PEDro scale, and data analyses were conducted using the CMA v3 random effects model. In total, 625 articles were reviewed, and data from 10 randomized controlled trials (RCTs) involving DS were used in this meta-analysis. The results showed that exercise programs were effective in increasing VO2peak (ml. kg -1min-1) (ES: 0.69; 95 % confidence interval [CI], 0.27-1.12; P: 0.001), time to exhaustion (ES: 0.83; CI, 0.31-1.35, P: 0.001), and VEpeak (ES: 0.76; CI, 0.32-1.20; P: 0.001). No changes were found for HRpeak (ES: 0.3; CI, -0.02-0.63, P: 0.07), VO2peak (ml·min-1) (ES: 0.45; CI, -0.01-0.92; P: 0.06), or RER (ES: 0.45; CI, -0.09-0.98, P: 0.10). No adverse effects were reported in any of the studies. In this meta-analysis and comprehensive review, exercise interventions may improve cardiovascular responses in DS; however, the association wasn't consistent across trials. RCTs with precise intervention criteria, large sample sizes, and long-term follow-up are needed in the future to demonstrate the benefits of exercise on cardiovascular responses in people with DS.

Motor Skills and Executive Functions in Pediatric Patients with Down Syndrome: A Challenge for Tailoring Physical Activity Interventions

Down syndrome (DS) is one of the most common chromosomal disorders. In addition to this variety of dysmorphic features. DS is also associated with a wide range of diseases and related comorbidities affecting different organs and systems. These comorbidities, together with societal and environmental influences, have a negative impact on physical activity in people with DS. Low levels of physical activity and energy expenditure have been identified as crucial players in worsening the acquisition of motor skills and executive functions. Executive functions are critical for the many skills (creativity, flexibility, self-control, and discipline) impacting our quality of life and make it possible to control impulses, mentally play with ideas, and stay focused. We proposed a broad overview of the available literature regarding motor skills and executive functions in pediatric patients with DS to understand the specific challenges for tailoring physical activity interventions. Motor skill interventions are effective in improving motor competence and performance on cognitive, emotional, and physical aspects in children with DS. Interventions based on executive functions in DS subjects are effective to contrast the cognitive decline and improve the everyday use of executive functions in youth and adults. Targeted interventions are mandatory for maximizing the benefits of physical activity, minimizing potential risks, and ultimately improving the overall health outcomes and quality of life for individuals with DS.

Using mobile health to encourage physical activity in individuals with intellectual disability: a pilot mixed methods feasibility study

Background

Many individuals with intellectual disability (ID) have a sedentary lifestyle. Few interventions aimed at increasing their level of physical activity (PA) have shown lasting effects.

Aim

To assess the feasibility and acceptability of a pilot intervention study using innovative mobile health (mHealth) support systems to encourage PA in individuals with ID.

Methods

Nine individuals with ID and a low level of PA, aged 16-36 years, were included in the present convergent triangulation mixed method design. Two mHealth support systems (apps) were developed and tested. PA was measured with a Fitbit smartwatch, accelerometer, the International Physical Activity Questionnaire-Short Form (IPAQ-S), and Goal attainment scaling. Data were collected through online pre-, mid- (4 weeks), and post-intervention (12 weeks) questionnaires and activity trackers. Semi-structured qualitative interviews with participants and/or a family or staff member were held after the 12-week follow-up. Data were analyzed using conventional nonparametric statistics and thematic analyses.

Results

The response rate and retention to the trial were 16% and 100%, respectively. Data quality was high, except for missing data from Fitbit activity trackers of approximately 30% from the 4- and 12-week follow-up stages. The feasibility challenges with activity trackers include rashes, size, non-acceptance, and loss of motivation. Participants and family members/staff reported interest in the study theme and were pleased with the data collection method. All but one participant achieved their PA goals. Most participants reported being satisfied with the apps as they were enjoyable or provided a reminder for performing physical and other activities. Social support for PA among family members also increased. However, app support from staff and family members was needed, and apps were not used regularly. Two of nine participants (22%) had increased their PA measured as steps per day with Fitbit at the 12-week follow-up.

Conclusions

The acceptability and feasibility of using tailored mobile applications in natural settings to increase PA among adults with ID are promising. This study aligns with previous studies in showing the challenges to increasing PA, which requires the inclusion of family members, staff, and stakeholders. The intervention requires modifications before a randomized controlled trial can be conducted.

Sports Games and Motor Skills in Children, Adolescents and Youth with Intellectual Disabilities

(1) Background: Sports games are one of the best ways of engaging in physical activity for individuals with intellectual disabilities (ID) and Down syndrome (DS). This systematic review of the current literature aims to identify and sum relevant data on motor skills and clarify whether there are positive effects of sports programs in motor skills games in children, adolescents, and youth with ID and DS. (2) Methods: The systematic review of the papers was carried out following the methodological guidelines and by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) consensus. The following electronic databases were researched: PubMed, MEDLINE, Google Scholar, ScienceDirect, and ERIC from 2001 to 2023. (3) Results: The basketball test battery can be used to improve and monitor basketball training. Basketball players with lower levels of ID achieved better results, especially those with disabilities of the II and III degrees. Futsal has a positive impact on the coordination, and the differences between the test results of the vertical jump with and without an arm swing, that can be seen indirectly as a coordination factor, were statistically significant. (4) Conclusions: Basketball is recommended as an effective and practical rehabilitation program for children, adolescents, and youth with ID and DS. Futsal is an interesting and helpful activity for individuals with ID as well.

Capabilities, Opportunities, and Motivation: Exploring Fitness Program Experiences of Adults with Intellectual and Developmental Disabilities

Although there are many benefits to regular engagement in physical activity, adults with intellectual and developmental disabilities often do not engage in or near the recommended amount of physical activity. Barriers, such as lack of perceived capability, accessible environments, transportation, social support, and or knowledgeable support staff, may limit participation in physical activity. The present study used qualitative methods to explore the experiences of adults with intellectual and developmental disabilities enrolled in a fitness program. We used field observations and photo-elicited semi-structured interviews to explore what capabilities, opportunities, and motivations facilitate or hinder engagement in fitness classes and their experiences in the program. We used the COM-B model to deductively interpret and analyze the data through thematic analysis. Major themes were identified around types of support and preferences for physical over sedentary activities. Instructor, client, and family support were identified as important in facilitating interest, engagement, and skill. Dependency on others for financial and transportation support was also reported as important for participants to access the fitness program. This study provides valuable insight into the interactions and experiences of adults with intellectual and developmental disabilities, including what keeps them engaged in a fitness program as it relates to capabilities, opportunities, and motivation.

Social Support Initiatives That Facilitate Exercise Participation in Community Gyms for People with Disability: A Scoping Review

People with disability report social support facilitates participation in physical activity. A scoping review explored social support strategies used to facilitate exercise participation for people with disability (aged ≥ 15 years) in community gym settings. Seven electronic databases were searched. Studies were screened for eligibility based on title and abstract followed by full-text review. Data were analysed using content analysis and narrative synthesis. Forty-two articles reporting data from 35 studies were included. Eight types of social support were identified: supervision (n = 30), peer support (n = 21), specialist support (n = 19), orientation (n = 15), education (n = 7), logistical support (n = 6), motivational support (n = 5) and organised social activities (n = 4). Direct supervision was typically provided 1:1 or in small groups by staff experienced working with people with disability. Peer support typically involved support from exercise group participants or a peer mentor. Specialist support was usually provided by a health or exercise professional either directly to people with disability or to the people providing support to them (e.g., trainer). Orientation to the gym environment, equipment and exercise program was usually provided over 1 or 2 sessions. Gym staff may use these strategies to guide the implementation of social supports within their facilities to promote social connectedness and participation for people with disability.

Progressive resistance training in young people with Prader-Willi syndrome: protocol for a randomised trial (PRESTO)

INTRODUCTION

Preliminary evidence suggests that progressive resistance training may be beneficial for people with Prader-Willi Syndrome (PWS), a rare genetic condition that results in muscle weakness and low muscle tone.To establish whether community-based progressive resistance training is effective in improving the muscle strength of people with PWS; to determine cost-effectiveness; and, to complete a process evaluation assessing intervention fidelity, exploring mechanisms of impact, understanding participant experiences and identifying contextual factors affecting implementation.

METHODS AND ANALYSIS

A multisite, randomised controlled trial will be completed. Sixty participants with PWS will be randomised to receive either progressive resistance training (experimental) or non-progressive exercise (placebo control). Participants will be aged 13 to 60 years, be able to follow simple instructions in English and have no contraindications to performing progressive resistance training. The experimental group will complete progressive resistance training two times weekly for 24 weeks supervised by an exercise professional at a community gym. The control group will receive all aspects of the intervention except progressive overload. Outcomes will be assessed at week 25 (primary endpoint) and week 52 by a blinded assessor. The primary outcome is muscle strength assessed using one repetition maximum for upper limb and lower limb. Secondary outcomes are muscle mass, functional strength, physical activity, community participation, health-related quality of life and behaviour. Health economic analysis will evaluate cost-effectiveness. Process evaluation will assess safety and intervention fidelity, investigate mechanism of impact, explore participant experiences and identify contextual factors affecting implementation. Data collection commenced in February 2020 and will conclude in September 2023.

ETHICS AND DISSEMINATION

Ethical approval was obtained from The Royal Children's Hospital Human Research Ethics Committee (HREC/50874/RCHM-2019) under the National Mutual Acceptance initiative. Research governance approvals were obtained from five clinical sites. Results will be disseminated through published manuscripts, conference presentations, public seminars and practical resources for stakeholder groups.

TRIAL REGISTRATION NUMBER

ACTRN12620000416998; Australian and New Zealand Clinical Trial Registry.

The Health Effects of 14 Weeks of Physical Activity in a Real-Life Setting for Adults with Intellectual Disabilities

Background

The life expectancy of individuals with intellectual disabilities (ID) is reduced compared to the general population, and one of the main contributors to earlier death is inactivity.

Aim

To investigate how 14 weeks of physical activity (PA) in a real-life setting affects cardiovascular fitness, body composition and bone health of adults with ID.

Methods

Adults with ID were recruited into a PA-group (N = 52) or a control group (CON, N = 14). The PA-group participated in 14 weeks of PA, and body composition, cardiovascular fitness and bone health were assessed before and after the intervention. Outcomes and Results. Cardiovascular fitness and body composition improved from pre to post within the PA-group: Heart rates (HR) during the last 30 seconds of two increments of a treadmill test, were reduced (3.2 km/h: -4.4 bpm, p < 0.05; 4.8 km/h: -7.5 bpm, p < 0.001) and fat mass was reduced (-1.02 kg, p < 0.05). A between-group difference in favour of the PA-group, were observed in whole body bone mineral density (BMD) (0.024 g/cm2, p < 0.05). Conclusions and Implications. Fourteen weeks of PA performed in a real-life setting increased cardiovascular fitness, reduced fat mass and improved BMD in the weight-bearing skeleton in the PA-group. Increased and regular PA seems to be a promising tool to promote physical health in adults with ID.

A 12-week exercise programme has a positive effect on everyday executive function in young people with Down syndrome: a pilot non-randomised controlled trial

BACKGROUND

Exercise has the potential to reduce cognitive decline in people with Down syndrome by maximising their cognitive function. The aim of the study was to determine the effect of regular exercise on cognitive functioning in young people with Down syndrome.

METHOD

People with Down syndrome were eligible if aged between 13 and 35 years and enrolled to participate in an exercise programme (called FitSkills). The intervention was a 12-week community-based exercise programme completed with a student mentor. Outcomes were assessed before (week 0) and immediately after (week 13) the intervention. Executive functioning (planning, response inhibition, attention shifting) was assessed using Tower of London, Sustained Attention to Response Task, CANTAB Intra-extra Dimensional Set Shift Test, Cognitive Scale for Down Syndrome, and Behaviour Rating Inventory of Executive Function (BRIEF). Working memory was assessed using the CANTAB Paired Associates Learning task, and information processing speed was assessed using the Motor Screening Task. Outcomes were analysed using ANCOVA with the baseline measure as the covariate.

RESULTS

Twenty participants (9 women; mean age 23.6 ± 6.6 years) enrolled. Between-group differences, in favour of the experimental group, were found for the global executive composite score of the BRIEF (mean difference -4.77 units, 95% CI -9.30 to -0.25). There were no between group differences for any other outcome measured.

CONCLUSION

Participation in a 12-week exercise programme was effective in improving everyday executive functions in young people with Down syndrome. These preliminary findings need to be confirmed in future randomised controlled trials of community-based exercise with larger sample sizes.

Field-based versus laboratory-based estimates of muscle quality index in adolescents with and without Down syndrome

BACKGROUND

Low muscle quality index (MQI) is a potential risk of developing functional impairments in older people. However, considering that individuals with Down syndrome (DS) present with a faster decline in biological aging, an investigation on MQI in individuals with DS is necessary. The aims of this present cross-sectional study were to compare (1) MQI between adolescents with and without DS and (2) evaluate laboratory versus field-based estimates of MQI.

METHODS

Fifty-six adolescents were recruited and separated into two groups: DS (n = 30, 13 boys and 17 girls; age: 12.38 ± 3.07 years) and a control (non-DS; n = 26, 9 boys and 17 girls; age: 12.46 ± 2.88 years). Laboratory MQI was derived from the ratio of grip strength to arm muscle mass (in kg) measured by dual-energy X-ray absorptiometry (DXA). Field-based MQI was quantified from the ratio of hand grip strength (HGS) to body mass index (BMI). For statistical analyses, a two-way ANOVA was conducted for group comparisons, and a Pearson correlation was used to test the association between field MQI and laboratory MQI.

RESULTS

Adolescents with DS displayed lower field (P = 0.001), laboratory MQI estimates (P = 0.001) and HGS (P = 0.001) as compared non-DS. Also, there was a strong correlation effect between field MQI and laboratory MQI estimates (P < 0.001, R = 0.81).

CONCLUSION

Adolescents with DS have lower field and laboratory MQI compared with adolescents without DS. Simpler field MQI might be used in daily clinical practice, with special attention to those with DS.

Resistance training and Down Syndrome: A narrative review on considerations for exercise prescription and safety

The current manuscript reviews the literature on the health effects of resistance training (RT) for individuals with Down syndrome (DS), focusing on this training modality’s methodology, application, and safety. The literature has mentioned that early aging in this population is associated with loss of muscle strength, lower lean and bone mass, and increased obesity. It is necessary to propose non-pharmacological measures for prevention and health promotion. Thus, this review suggests a current research-based RT guide for individuals with DS. This review is divided into three sections: Section 2 briefly reviews DS and the effects on structural and functional decline and how exercise and physical activity can influence health aspects in this population; Section 3 summarizes the evidence for RT prescription; Section 4 briefly reviews the health and potential benefits of RT in individuals with DS. The findings from this review suggest that most individuals with DS should engage in moderate-intensity RT at least 2 days a week and perform RT on the major muscle groups and include balance training. The RT program should be modified and adapted according to individuals’ characteristics and limitations. RT promotes positive, health-related benefits such as increasing strength, improving body composition, improving functional capacity and balance, reducing inflammatory status and oxidative stress, and improving the immune system. The RT protocols summarized in this current review provide guidance, critical conclusions, and novel research settings, which could be useful to coaches, clinicians, and researchers to effectively design RT program for individuals with DS.

Neuromuscular exercise in children with Down Syndrome: a systematic review

The effects and the prescription parameters of therapeutic exercise are not clear. For this reason, is needed to determine the effect of neuromuscular exercise on balance, muscle strength and flexibility specifying the parameters and characteristics of effective interventions in children between 6 and 12 years and adolescent between 13 and 18 years with Down Syndrome. The present study is a systematic review of effectiveness outcomes balance, muscle strength and flexibility in this population. The databases of PubMed, PEDro, EMBASE, SCIELO, Lilacs, Cochrane library were searched from May to December 2021. We recruited randomized controlled trials (RCTs) which met the inclusion criteria in our study. Ten studies were included. The interventions included mechanotherapy, vibration, and use of different unstable surfaces. The exercise frequency ranged from 3 to 5 days a week, and the duration of each session was between six and 15 min. The frequency was between two and three times a week for 6 and 12 weeks and the intensity were between 60 and 80% of maximal voluntary contraction. Neuromuscular exercise in different modes of application was associated with increases in chest and lower limb muscle strength mean 8.51, CI [2.35-14.67] kg and (21.54 [1.64, 41.43]) kg. Balance also improved when the mode of application was isokinetic training and core stability exercises (- 0.20 [- 0.29, - 0.12]) evaluated with stability index. Neuromuscular exercise appears to be effective for the improvement of both lower limb and chest muscle strength and balance in children over 8 years. No evidence was found in children under 8 years.

Prenatal and Postnatal Therapies for Down's Syndrome and Associated Developmental Anomalies and Degenerative Deficits: A Systematic Review of Guidelines and Trials

Down's syndrome (DS) is the most common genetic disorder at birth. Multiple developmental abnormalities before birth and early onset of degenerative deficits after birth are features of DS. Early treatment for the manifestations associated with DS in either prenatal or postnatal period may improve clinical outcomes. However, information available from professional bodies and to communities is very limited. We carried out a systematic review and attempted meta-analysis of clinical trials for developmental abnormalities and degenerative deficits in DS. Only 15 randomized controlled trials (RCTs) in 995 (24 days to 65 years old) individuals with DS showed some improvement in cognitive disorders, development and growth, and musculoskeletal problem. However, each trial used different parameters and methods to measure various outcomes. RCTs of prenatal interventions in fetus with DS are lacking. The efficacy and safety of specific interventions in DS are still largely unknown. Proper counseling of the potential treatment for pregnant mothers who wish to continue their pregnancy carrying fetus with DS, and to health care professionals who take care of them are not adequate nowadays.

Changes in physical activity across a 6-month weight loss intervention in adolescents with intellectual and developmental disabilities

BACKGROUND

Adolescents and young adults with intellectual and developmental disabilities (IDD) have high rates of obesity and low levels of physical activity. This analysis examined changes in light, moderate-to-vigorous physical activity (MVPA) and sedentary time, and the association between changes in MVPA and weight loss in adolescents and young adults with IDD and overweight and obesity participating in a 6-month multi-component weight loss intervention.

METHODS

Adolescents and young adults with IDD and overweight or obesity (body mass index ≥ 85 percentile, n = 110, age ~16 years, 52.7% female) and a parent were randomised to one of three intervention groups: face-to-face delivery/conventional reduced energy diet (n = 36), remote delivery (RD)/conventional reduced energy diet (n = 39), or RD/reduced energy enhanced stop light diet (eSLD) (n = 35.) Participants were asked to engage in 60 min/day of MVPA on 5 or more days/wk. Participants and a parent attended twice monthly education/behavioural counselling sessions with a health educator to assist participants in complying with dietary and MVPA recommendations. Education/counselling in the RD arms was delivered remotely using video conferencing, and self-monitoring of MVPA and daily steps was completed using a wireless activity tracker. Education/counselling in the face-to-face arm was delivered during home-visits and self-monitoring of MVPA and daily steps was completed by self-report using paper tracking forms designed for individuals with IDD. MVPA, light activity, and sedentary time were assessed over 7 days at baseline and 6 months using a portable accelerometer (ActiGraph wGT3x-BT).

RESULTS

Mixed modelling analysis completed using participants with valid accelerometer data (i.e. ≥4-10 h days) at baseline (n = 68) and 6 months (n = 30) revealed no significant changes in light, moderate- MVPA, or sedentary time across the 6-month intervention (all P > 0.05). Participants obtained 15.2 ± 21.5 min/day of MVPA at baseline and 19.7 ± 19.7 min/day at 6 months (P = 0.119). Mixed modelling indicated no significant effects of group (P = 0.79), time (P = 0.10), or group-by-time interaction (P = 0.21) on changes in MVPA from baseline to 6 months. Correlational analysis conducted on participants with valid accelerometer data at both baseline and 6 months (n = 24) revealed no significant associations between baseline sedentary time (r = 0.10, P = 0.40) and baseline MVPA (r = -0.22, P = 0.30) and change in MVPA across the 6-month intervention. Additionally, attendance at education/counselling sessions (r = 0.26, P = 0.22) and frequency of self-monitoring of MVPA were not significantly associated with change in MVPA from baseline to 6 months (r = 0.26, P = 0.44). Baseline MVPA (r = 0.02, P = 0.92) and change in MVPA from baseline to 6 months (r = 0.13, P = 0.30) were not associated with changes in body weight across the 6-month intervention.

CONCLUSION

We observed a non-significant increase in MVPA (30%), which was not associated with the magnitude of weight loss in a sample of adolescents and young adults with IDD who participated in a 6-month multi-component weight loss intervention. Additional strategies to increase MVPA in adolescents and young adults with IDD participating in weight loss interventions need to be developed and evaluated.

Intrapersonal, interpersonal and environmental correlates of moderate to vigorous physical activity and sedentary time in adolescents with intellectual and developmental disabilities

BACKGROUND

Although correlates of physical activity (PA) have been extensively examined in both children and adolescents who are typically developing, little is known about correlates of moderate to vigorous physical activity (MVPA) and sedentary time in adolescents with intellectual and developmental disabilities (IDD). Therefore, we examined intrapersonal, interpersonal and environmental factors and their association with device-based MVPA and sedentary time in adolescents with IDD.

METHODS

MVPA and sedentary time was assessed using a hip-worn ActiGraph model wGT3x-BT tri-axial accelerometer across a 7-day period in adolescents with IDD and one of their parents. Pearson and point-biserial correlations were calculated to inspect the associations of PA (MVPA, sedentary time) with intrapersonal factors (demographic characteristic, BMI, waist circumference, motor ability, muscle strength, grip strength, cardiovascular fitness and self-efficacy for PA), interpersonal factors (parent demographics, parent BMI, parent MVPA and sedentary time, family social support for PA, parent barriers and support for PA, parent's beliefs/attitudes towards PA and number of siblings), and environmental factors (meteorologic season and COVID-19). Ordinary least squares regression was used to estimate the unique contributions of key factors to PA after controlling for participants' age, sex, race, waist circumference and total wear time.

RESULTS

Ninety-two adolescents (15.5 ± 3.0 years old, 21.7% non-White, 6.5% Hispanic, 56.5% female) provided valid accelerometer data. Average sedentary time was 494.6 ± 136.4 min/day and average MVPA was 19.8 ± 24.2 min/day. Age (r = 0.27, P = 0.01), diagnosis of congenital heart disease (r = -0.26, P = 0.01) and parent sedentary time (r = 0.30, P = 0.01) were correlated with sedentary time. BMI (r = -0.24, P = 0.03), waist circumference (r = -0.28, P = 0.01), identifying as White (r = -0.23, P = 0.03) and parent MVPA (r = 0.56, P < 0.001) were correlated with MVPA. After adjusting for the adolescent's age, sex, race, waist circumference, and total wear time, the association between parent and adolescent MVPA remained significant (b = 0.55, P < 0.01, partial η2  = 0.11).

CONCLUSION

The results of this study provide evidence that race, waist circumference and parental MVPA may influence the amount of MVPA in adolescents with IDD. The limited available information and the potential health benefits of increased MVPA highlight the need to evaluate the effectiveness of multi-component interventions targeting both intrapersonal and interpersonal levels to promote increased PA in adolescents with IDD.

Interventions for Transition-Age Youth With Disabilities: A Meta-Analysis of Group Design Studies

This meta-analytic review investigated interventions for transition-age youth diagnosed with autism, intellectual disability, or extensive support needs. Nineteen group design studies with 215 effect sizes met inclusion criteria. A robust variance estimation procedure that accounts for the clustering effect sizes within studies was used to synthesize effect sizes within each intervention and outcome type. Occupational Therapy/Physical Therapy interventions have significant and positive effects on gross motor outcomes (g = 0.73, p < 0.01). All remaining interventions and outcomes could not be synthesized due to a limited number of studies, but are further described in a narrative manner. Recommendations for future research include improving the methodological quality of intervention studies and further analyzing the effects of interventions for transition-age youth.

Interventions for health-related physical fitness and overweight and obesity in children with intellectual disability: Systematic review and meta-analysis

BACKGROUND

Poor health-related physical fitness (HRPF) and overweight and obesity are common health problems for children with intellectual disability. This study aimed to review existing lifestyle intervention studies, and identify effective strategies for this population.

METHODS

A systematic search was undertaken in three databases. The random-effects model was used to pool the weighted results by inverse variance methods, and the I² statistic was applied to assess heterogeneity among the included studies.

RESULTS

Most of the identified interventions (27/29) adopted physical activity (PA). For obesity-related outcomes, the results showed no significant effect of PA studies on reducing obesity. For HRPF outcomes, significant effects were found on 6-min walk distance (51.86 m, 95% CI [16.49, 87.22], p < .05).

CONCLUSIONS

PA is the predominant intervention component adopted and may contribute to improving cardiopulmonary fitness; but the lack of research limits our ability to draw any confirmed conclusion on obesity-related outcomes and other HRPF outcomes.

Mobile health support to stimulate physical activity in individuals with intellectual disability: Protocol for mixed methods pilot study (Preprint)

Background

Several studies have shown that individuals with intellectual disabilities (IDs) have low levels of physical activity (PA), and intervention studies on PA suggest inconsistent evidence. The use of technology as a means of motivation for PA has yet to be extensively explored and needs to be further investigated.

Objective

We aim to assess the feasibility and acceptability of procedures for an intervention arm in a future trial on mobile health (mHealth) to support PA for individuals with IDs. In addition, we aim to examine how the use of technology can influence motivation for PA among participants, their caregivers, and staff members.

Methods

A mixed methods pilot study of an intervention arm will be carried out in a planned randomized controlled trial (RCT). Ten participants with ID and their caregivers or a staff member will be included. Information will always be provided by a caregiver or a staff member, or participants with ID if possible. Assessments will be carried out at baseline, follow-up after 4 weeks, and 12 weeks, and include questionnaires on PA, social support, self-efficacy, and challenging behavior. PA will be measured with 2 different activity trackers (Fitbit and Axivity) for 1 week at all assessments. Feasibility will be assessed as recruitment and adherence rate, missing data, usability of the motivational mHealth tool, and estimates of effectiveness. Acceptability of study procedures, activity measures, and motivation for participation in PA will be additionally assessed with qualitative methods at the end of the intervention.

Results

Enrollment commenced in May 2021. Data collection was completed in March 2022.

Conclusions

This pilot study will evaluate the feasibility and acceptability of study procedures of the intervention arm of a planned RCT to address feasibility issues, improve study procedures, and estimate effectiveness of the study measures. How the use of technology can influence motivation for PA will also be examined, which can help guide and improve future PA interventions involving the use of technology.

Trial Registration

ClinicalTrials.gov NCT04929106; https://clinicaltrials.gov/ct2/show/NCT04929106

International Registered Report Identifier (IRRID)

DERR1-10.2196/37849

Brief report: Caregiver perceived physical activity preferences of adults with Down syndrome

BACKGROUND

Adults with Down syndrome commonly have low levels of physical activity and face social barriers to engaging in physical activity, including boredom and companionship concerns. Adults with Down syndrome are at increased risk for several co-occurring medial conditions known to benefit from physical activity, including obesity and dementia.

METHOD

This study surveyed 140 caregivers of adults with Down syndrome to determine the physical activity preferences of their adult with Down syndrome.

RESULTS

Dancing was the most frequently caregiver-reported physical activity preference for adults with Down syndrome, followed by walking and active video gaming. Rowing, using an elliptical machine, and jogging were the least preferred activities. Most caregivers reported that their adult with Down syndrome has a companion available for physical activity.

CONCLUSION

Promoting dance in adults with Down syndrome, a caregiver-reported preferred form of physical activity, may help improve physical activity levels and decrease sedentary behaviours in this population.

Barriers and Facilitators of Physical Activity Participation among Children and Adolescents with Intellectual Disabilities: A Scoping Review

Background: Children and adolescents with intellectual disabilities (ID) have low levels of physical activity (PA). Understanding factors influencing the PA participation of this population is essential to the design of effective interventions. The purposes of this study were to identify and map the barriers and facilitators of PA participation among children and adolescents with ID. Methods: A scoping review was conducted in accordance with established methodology. Articles were evaluated for relevance using predetermined inclusion criteria in eight databases. Extracted barriers and facilitators were classified using the social ecological model as individual, interpersonal, or environmental factors. Results: Thirty-two studies published between 1992 and 2020 were included (24 quantitative, 6 qualitative, and 2 mixed-method). Thirty-four factors were identified. The most commonly reported barriers included disability-specific factors, low self-efficacy, lack of parental support, inadequate or inaccessible facilities, and lack of appropriate programs. The most commonly reported facilitators included high self-efficacy, enjoyment of PA, sufficient parental support, social interaction with peers, attending school physical education (PE) classes, and adapted PA programs. Conclusions: Continued exploration of factors influencing PA participation is required among children and adolescents with ID. Future interventions should involve families, schools, and wider support network in promoting their PA participation together.

Weight management recommendations for youth with Down syndrome: Expert recommendations

Youth with Down syndrome (DS) have a higher prevalence of overweight and obesity compared to the general youth population. Due to physiological and cognitive differences observed in youth with DS, weight management recommendations developed for the general population, may not be suitable for youth with DS. However, there are no recent recommendations for weight management in youth with DS. A workgroup of clinicians and researchers with extensive experience working with youth with DS came together to give clinicians and families guidance for weight management in youth with DS. Recommendations were developed by the workgroup via a methodical, deliberative process. After the initial development of the recommendations, they were shared with an expert review panel and caregivers who rated the strength of the recommendation and strength of the evidence. The workgroup moved forward the recommendations which the review panels rated as strong. Eight recommendations were developed which focused on screening for overweight and obesity, screening for health conditions that may impact dietary intake and physical activity, screening for feeding difficulties, setting appropriate recommendations for dietary intake and physical activity, and well as prevention and treatment of overweight and obesity using evidence-based strategies. These recommendations can be implemented by clinicians working with youth with Down syndrome as well as the family, school, and other relevant entities.

Promoting the Participation of Children and Adolescents With Disabilities in Sports, Recreation, and Physical Activity

The benefits of physical activity are likely universal for all children, including children and adolescents with disabilities (CWD). The participation of CWD in physical activity, including adaptive or therapeutic sports and recreation, promotes inclusion, minimizes deconditioning, optimizes physical functioning, improves mental health as well as academic achievement, and enhances overall well-being. Despite these benefits, CWD face barriers to participation and have lower levels of fitness, reduced rates of participation, and a higher prevalence of overweight and obesity compared with typically developing peers. Pediatricians and caregivers may overestimate the risks or overlook the benefits of physical activity in CWD, which further limits participation. Preparticipation evaluations often include assessment of health status, functional capacity, individual activity preferences, availability of appropriate programs, and safety precautions. Given the complexity, the preparticipation evaluation for CWD may not occur in the context of a single office visit but rather over a period of time with input from the child's multidisciplinary team (physicians, coaches, physical education teachers, school nurses, adaptive recreation specialists, physical and occupational therapists, and others). Some CWD may desire to participate in organized sports to experience the challenge of competition, and others may prefer recreational activities for enjoyment. To reach the goal of inclusion in appropriate physical activities for all children with disabilities, child, family, financial, and societal barriers to participation need to be identified and addressed. Health care providers can facilitate participation by encouraging physical activity among CWD and their families during visits. Health care providers can create "physical activity prescriptions" for CWD on the basis of the child's preferred activities, functional status, need for adaptation of the activity and the recreational opportunities available in the community. This clinical report discusses the importance of participation in sports, recreation, and physical activity for CWD and offers practical suggestions to health care providers.

A Resistance Training Intervention for Adults With Intellectual Disability in the Community: A Pilot Randomized Clinical Trial

Adults with an intellectual disability have significantly lower levels of fitness compared with the general population. This study examined the effects of a 13-week theoretically guided, community-based, multicomponent resistance training intervention, resistance training for empowerment, on muscular strength and independent functional performance in 24 adults with an intellectual disability, aged 18-44 years. Twelve participants were randomly allocated to an experimental group and 12 to an active control group. An analysis of covariance revealed that the experimental group had significantly greater increases (p < .05) on the chest press and leg press one-repetition maximum tests and the 6-min walk test from the baseline to postintervention compared with the control group. The experimental group correctly and independently performed a significantly greater number of steps of resistance training exercise tasks than the control group. Marginal significance and large effect sizes were found for the prone plank test and the stair climb test. The resistance training for empowerment was effective in promoting muscular strength and independent functional performance among adults with an intellectual disability.

Prescription and Effects of Strength Training in Individuals with Intellectual Disability-A Systematic Review

The practice of physical exercise (PE), especially strength training (ST), has health benefits in the healthy population; however, the literature is scarce in the recommendations related to the population with intellectual disability (ID). This study represents the first analysis on the topic and aims to examine the structure and efficacy of ST experimental intervention programs in individuals with ID. This systematic review was carried out between January and April 2021, using the PubMed, Web of Science, Scopus, and SPORTDiscus databases, according to the PRISMA guidelines. From a total of 166 studies, eight were included in the present systematic review. The studies included a total of 280 individuals (18.23 ± 2.86 years old). The main features of the exercise programs are: 12 weeks average duration, three weekly sessions of 45–60 min, six to seven exercises targeting the main muscle groups, two to three sets, 6–12 repetitions, and avoiding free weights for safety reasons. The main results showed increments in strength, balance and fat-free mass and decrements in fat mass and waist circumference. It is a useful guideline for PE technicians to prescribe and adjust correctly in order to not only promote physical fitness, but improve the quality of life of individuals with ID.

Effects of Resistance Training in Muscle Mass and Markers of Muscle Damage in Adults with Down Syndrome

Recent studies have emphasized that regular exercise should be encouraged as a key part of care and support for people with Down syndrome (DS). However, muscle hypotonia has traditionally been considered a major barrier to resistance training (RT) in people with DS. The main objective of this study was to analyze the impact of circuit RT on markers of muscle damage. The secondary objective was to assess the influence of a RT program on body composition and work task performance. Thirty-six men with DS were recruited and randomly assigned to perform a circuit RT program with six stations 3 days/week for 12 weeks (n = 18) or to a control group (n = 18). Body composition was assessed by bioelectrical impedance analysis. Serum markers of muscle damage (creatine kinase, myoglobin, and lactate dehydrogenase) were determined at baseline and at the end of training weeks 1, 6, and 12. Work task performance was assessed using the weighted pail-carry test. RT did not induce significant changes in markers of muscle damage during the intervention. Furthermore, muscle mass and work task performance were significantly improved in the exercise group. These findings suggest that circuit RT can be used safely to increase muscle mass and work task performance in young adults with DS. Muscle hypotonia should not be considered a major barrier to exercise in people with DS, provided that qualified staff design and supervise all training sessions.

Executive Function Improves Following Acute Exercise in Adults with Down Syndrome

The influence of exercise on brain function is an important topic, especially in persons with intellectual deficits. The aim of this study is to determine the effect of an acute bout of resistance training (RT) compared to assisted cycle therapy (ACT) and no training (NT) in adults with DS on cognitive function. Fourteen participants attended four sessions: a baseline assessment, an assisted cycling therapy (ACT) session, a resistance training (RT) session, and a session of no training (NT). In the RT session, the leg press, chest press, seated row, leg curl, shoulder press, and latissimus pulldown were performed. The ACT session consisted of 30 min of cycling and in NT session consisted of 20 min of board games. Inhibition was measured by the Erikson flanker task and cognitive planning was measured by the Tower of London test and both were administered prior to (pretest) and after each intervention (posttest). Our results showed that inhibition time improved more following RT and ACT than NT. There was also a significant difference between ACT and NT. For cognitive planning, improvements were seen following ACT and NT. In conclusion, an acute session of ACT demonstrated a significant trend towards improvements in executive functions in adults with DS which we interpreted using a model of neural changes and the cognitive stimulation hypothesis.

Promoting Participation in Physical Activity in Children and Adolescents With Down Syndrome

Children with Down syndrome (DS) often have lower physical activity (PA) levels compared with their peers with typical development, and face challenges to being physically active such as medical comorbidities, access issues, and societal stigma. Physical therapists are experts in exercise prescription and PA and are thus uniquely qualified to successfully promote participation in children with DS, in spite of inherent challenges. Our perspective is that a shift in physical therapy service delivery is needed. We suggest that physical therapists change the focus of their interventions for children with DS from underlying impairments such as low tone or joint laxity or from developing motor skills in isolation and "correct" movement patterns. Instead, physical therapists should allow the PA preferences and the environmental contexts of the children and adolescents they are working with to direct the treatment plan. In this way, physical therapist intervention becomes more child centered by concentrating on developing the specific skills and strategies required for success in the child's preferred PA. In this article, we consider the role of pediatric physical therapists in the United States, as well as in low- and middle-income countries, in promoting and monitoring PA in children with DS from infancy through adolescence. Examples of physical therapist interventions such as tummy time, movement exploration, treadmill training, bicycle riding, and strength training are discussed, across infancy, childhood, and adolescence, with a focus on how to successfully promote lifelong participation in PA.

LAY SUMMARY

Physical therapists are experts in exercise and physical activity and are thus uniquely qualified to promote participation in children with Down syndrome. Instead of focusing on impairments or "correct" movement patterns, physical therapists are encouraged to allow the child and the child's environment to direct the treatment plan.

Current Trends in Pediatric Physical Therapy Practice for Children With Down Syndrome

BACKGROUND

Physical therapists (PTs) have a broad range of approaches to the management of Down syndrome (DS).

PURPOSE

To examine the breadth of physical therapy practice for children with DS.

METHODS

A survey was distributed to 1000 randomly selected members of the Academy of Pediatric Physical Therapy.

DATA ANALYSIS

Responses were categorized into 13 thematic subcategories and 3 International Classification of Functioning, Disability and Health (ICF) subcategories.

RESULTS AND DISCUSSION

One hundred eight PTs participated. Joint stability and alignment were the most common physical therapy-related problem. Functional movement was the most common physical therapy intervention. Most clinicians identified and treated at the ICF level of body functions and structure. Multiple assessment tools were used and tended to include norm-referenced tests. There was diversity of interventions with varying amounts of supporting evidence.

CONCLUSIONS

PTs manage children with DS for a wide variety of needs with a variety of interventions.

Feasibility of scaling-up a community-based exercise program for young people with disability

PURPOSE

To evaluate feasibility of scaling up a 12-week community-based exercise program (FitSkills) in which young people with disability exercise with a student mentor.

METHOD

Within a stepped wedge cluster randomised trial, seven domains of feasibility were assessed: demand, implementation, acceptability, practicality, adaptation, integration, and expansion.

RESULTS

Of the 163 participants with disability (61 females; 20.8 ± 5 y) and 226 mentors who enrolled, 123 participants and mentors completed FitSkills. Population demand was estimated at 9% of members of participating organisations. Most participants (76%) completed the twice-weekly program within 12 weeks, attending 79% of sessions (mean 18.9 ± 4.7). Key program elements valued by participants were the mentor, tailored exercise, and regular program schedule. Majority (87%) of mentors were recruited from physiotherapy, occupational therapy, and exercise science courses. Positives for participants were perceived benefits and organisational support, and for mentors, understanding disability. Communication and scheduling were burdens. Three serious and 28 non-serious adverse events occurred. Adaptations (additional screening, risk analysis, extra mentor support, or in-person consultation) enabled 29 young people with complexity to participate. The number of trial sites was expanded to 11 to accommodate participants.

CONCLUSIONS

Scaling-up FitSkills is feasible, but with caveats related to communication, scheduling, and efficiency of recruitment.IMPLICATIONS FOR REHABILITATIONKey elements valued by participants as part of the successful scale-up of a community-based exercise program (FitSkills) across a large metropolitan city included a peer-mentor, tailored exercise, and organisational support structure.FitSkills can be adapted to include young people with complex disability with additional supports including screening, risk analysis, and professional support for the peer-mentor.The benefits of FitSkills, including social connectedness for young people with a disability and normalisation of disability for mentors, outweigh the burdens of participation.Communication with program organisers and scheduling logistics between the young person, their family/carers and peer mentors are important factors to manage for the successful implementation of FitSkills.

Effects of a School-Based Physical Activity Intervention for Obesity and Health-Related Physical Fitness in Adolescents With Intellectual Disability: Protocol for a Randomized Controlled Trial

BACKGROUND

Childhood obesity accompanied by lower levels of health-related physical fitness (HRPF) is a major threat to public health both internationally and locally. Children with intellectual disability, especially adolescents, have a higher risk of being overweight/obese and having poor HRPF levels. Therefore, more interventions are needed to help this population attain their optimal health levels. However, there has been relatively limited research on this population compared with on their typically developing peers.

OBJECTIVE

The proposed study aims to fill this knowledge gap by developing and examining the success of a physical activity (PA) intervention for the target population.

METHODS

The proposed study will be a 12-week, school-based randomized controlled trial. The participants (N=48) will be recruited from special schools for students with mild intellectual disability and then randomly allocated to either the intervention group (IG) or the wait-list control group (CG). During the intervention period, the participants in the IG will receive a fun game-based moderate-to-vigorous PA (MVPA) training program (2 sessions/week, 60 minutes/session, for a total of 24 sessions). The intensity of the activities will increase in a progressive manner. Participants in the CG will receive no program during the study period, but the same PA program will be provided to them after the completion of the study. To observe and evaluate the sustaining effects of the intervention, follow-up testing will be scheduled for the participants 12 weeks after the intervention concludes. The study outcomes will include primary outcomes (obesity- and fitness-related outcomes) and a secondary outcome (blood pressure). All of the measurements will be taken at 3 time points. After the follow-up tests, the same PA training program will be provided to the participants in the CG.

RESULTS

This study is ongoing. The participants were recruited from October 2020 to November 2020. The total duration of the study is 13 months. Study results are expected at the end of 2021.

CONCLUSIONS

The proposed study is expected to reduce obesity and improve HRPF levels in children with intellectual disability. If proven effective, the intervention will be made accessible to more special schools and mainstream schools with students with intellectual disability. Furthermore, the study can serve as an example for international researchers, policy makers, and members of the public who are seeking to tackle the problem of obesity and poor HRPF among children with intellectual disability.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04554355; https://www.clinicaltrials.gov/ct2/show/NCT04554355.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/25838.

Changing Student Health Professionals' Attitudes toward Disability: A Longitudinal Study

Purpose: The purpose of this study was to determine whether positive changes in self-reported attitudes toward disability were retained after students had participated in a 12-week voluntary community-based exercise programme for young people with disability. Method: Sixty-eight physiotherapy and exercise physiology students (45 women, 23 men; mean age 21 y) volunteered. Each student was matched with a young person with disability, and the pair exercised together twice a week for 12 weeks at their local gymnasium. The primary outcome measure was self-reported attitude toward disability. Secondary outcomes were self-reported professional skills competency, confidence, future work intentions, and motivations for volunteering. The outcomes were measured at Weeks 0, 13, and 24. The data were analyzed using generalized linear mixed-effects models, ordinal regression, and linear regression. Results: The students' attitudes toward disability were more positive at Weeks 13 and 24 than at baseline, but positive changes were not fully retained by Week 24. Small statistically significant reductions occurred after Week 13. Self-reported skills competencies, confidence, and future intentions of working in disability were higher at Weeks 13 and 24. Students' motivation for volunteering was wanting to support others, wanting to learn, and perceived positive career effects. Conclusions: Positive changes in students' attitudes toward disability were generally retained 3 months after volunteering in a community-based exercise programme.

Adaptations to Swimming Training in Athletes with Down's Syndrome

Swimming training programs may help to limit declines in cardiovascular conditioning, muscle strength, mobility and social functioning in individuals with Down’s Syndrome (DS): (1) Background: This study aims to analyze the effects of a periodized swimming training program on swimming speed, lower body force and power and body composition in a group of swimmers with DS; (2) Methods: Nine swimmers with DS (2 men and 7 women; aged 21–30 years-old) completed an 18-week periodized swimming program. The swimmers were assessed, pre and post-training, for 25 m, 50 m and 100 m freestyle swim performance, countermovement jump performance and body composition; (3) Results: Significant and large improvements in 25 m (mean −6.39%, p < 0.05, d = 1.51), 50 m (mean −4.95%, p < 0.01, d = 2.08) and 100 m (mean −3.08%, p < 0.05, d = 1.44) freestyle performance were observed following training, with no significant changes in body composition or consistent changes in jump performance (although a large mean 14.6% decrease in relative peak force, p < 0.05, d = 1.23) (4) Conclusions: A periodized 18-week training intervention may improve swimming performance in a small group of trained swimmers with DS, with less clear changes in jump performance or body composition. This program provides a training profile for coaches working with swimmers with DS and a platform for further research into the benefits of swimming training with this under-represented population.

The effect of 8 weeks of freestyle swim training on the functional fitness of adults with Down syndrome

BACKGROUND

Studies conducted on adults with Down syndrome have demonstrated the improvement of functional fitness (aerobic capacity, muscular strength, balance, flexibility, functional ability, body mass or body mass index) with varying exercise modalities but often with one or two components in isolation. Such modalities included walking, running, cycling, rowing or resistance training. Freestyle swim training has shown significant improvements of all parameters associated with functional fitness in the general population. Swimming is an aerobic activity where many of the large muscle groups are involved and may provide more functional fitness benefits. As a consequence, the purpose of our study was to investigate the effect of freestyle swim training on the functional fitness of adults with Down syndrome.

METHODS

Twenty-six adults with Down syndrome (33 ± 6 years; 34 ± 9 kg/m² ) were randomly allocated to an exercise (n = 13; 81.3 kg) or control group (n = 13; 81.5 kg). The exercise group performed 8 weeks of freestyle swim training, three times a week, 30 min per session (increased to 40 min after 4 weeks). To evaluate differences between groups, a one-way analysis of variance was used, controlling for differences at baseline.

RESULTS

After 8 weeks of training, the results showed significant differences between the exercise and control group for body mass, body mass index, aerobic capacity, dynamic balance, muscular strength, 12-m swim time and functional ability (P < 0.05). Effect sizes ranged from small to large.

CONCLUSIONS

Various components of functional fitness improved significantly after an intervention period of freestyle swim training. The collective improvement of many functional fitness parameters shown by this study may hold benefits for these often-neglected and in many cases functionally impaired individuals.

The promotion of physical activity for the prevention of Alzheimer's disease in adults with Down Syndrome: Rationale and design for a 12 Month randomized trial

Nearly all individuals with Down Syndrome (DS) display pathology associated with Alzheimer's disease (AD) beginning as early as age 30. Previous research in typically developed adults suggests that increased moderate-to-vigorous physical activity (MVPA) may improve cognitive function and protect against age-related structural and functional changes in the brain; however, the potential impact of increased MVPA on the development of AD in adults with DS has not been evaluated. Despite the potential positive impact of MVPA on cognition and AD risk, participation in MVPA among young adults with DS is low. The limited research evaluating strategies for increasing MVPA in adults with DS has been unsuccessful in increasing MVPA. Results from our preliminary investigation where we remotely delivered real-time MVPA, led by a trained health educator, to groups of adults with DS in their homes via video conferencing on a tablet computer demonstrated high attendance, increased MVPA during group sessions, and improvements in cognitive function. However, the sustainability, impact on total daily MVPA, optimal session frequency, and potential impacts on cognitive function and brain health of remotely delivered group MVPA sessions in adults with DS are unknown. Therefore, we will conduct a trial in 80 non-demented adults with DS to determine the feasibility and potential efficacy of remotely delivered group MVPA sessions to increase daily MVPA, relative to a usual care control. Secondarily we will assess the impact of MVPA on cardiovascular fitness, quality of life, cognitive function and brain parameters related to AD.

NCT REGISTRATION

NCT04048759.

Improvements in biometric health measures among individuals with intellectual disabilities: A controlled evaluation of the Fit 5 program

BACKGROUND

Individuals with intellectual disabilities (ID) have poorer health statuses compared to the general population. Actions are needed to address health disparities and promote healthy lifestyles among individuals with ID. Moreover, studies that consider program settings for this population are needed.

OBJECTIVE

The Special Olympics health program, Fit 5, was evaluated to assess effectiveness in improving health measures for individuals with ID. The settings of programs' implementation were also considered.

METHODS

Four Special Olympics basketball teams participated as an intervention group, and three teams as a control group, in a study of the Fit 5 program that was implemented during, and as part of, a regular 8-week basketball season. Resting heart rate (RHR) and blood pressure, and height and weight to calculate Body Mass Index (BMI), were measured before and after the program. Differences in pre- and post-measures were compared between the two groups with paired samples t-tests and ANCOVA.

RESULTS

Participants in the intervention group had significantly greater improvements in resting systolic and diastolic blood pressures (p = 0.02 and 0.03, respectively) and RHR (p = 0.003). BMI increased for both groups; however, the increase in the intervention group was significantly less (p = 0.006). The Special Olympics setting was considered familiar and supportive and effectively reached individuals with ID.

CONCLUSION

The Fit 5 program positively impacts RHR and blood pressure, and could help reduce extents of BMI increases, in individuals with ID when implemented in a common setting. Further investigation of the impact of Fit 5 and similar programs in additional settings is warranted.

FitSkills: protocol for a stepped wedge cluster randomised trial of a community-based exercise programme to increase participation among young people with disability

INTRODUCTION

There is a need to develop relevant, acceptable initiatives that facilitate physical activity participation in young people with disability. FitSkills was developed to support young people with disability to exercise. The primary aims are to investigate if FitSkills can be scaled up from a small, university-led programme to run as a larger community-university partnership programme, and to determine its effectiveness in improving physical activity participation and health-related quality of life for young people with disability. The secondary aims are to evaluate cost-effectiveness, changes in attitudes towards disability and other health-related outcomes for young people with disability.

METHODS AND ANALYSIS

A stepped wedge cluster randomised trial using a cohort design and embedded health economic evaluation will compare the effect of FitSkills with a control phase. FitSkills matches a young person with disability with a student mentor and the pair exercise together at their local gymnasium for 1 hour, two times per week for 12 weeks (24 sessions in total). One hundred and sixty young people with disability aged 13 to 30 years will be recruited. Eight community gymnasia will be recruited and randomised into four cluster units to have FitSkills introduced at 3-month intervals. Primary (feasibility, participation and health-related quality of life) and secondary outcomes will be collected longitudinally every 3 months from trial commencement, with eight data collection time points in total. The Practical Robust Implementation and Sustainability Model will be used to support knowledge translation and implementation of project findings into policy and practice.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the La Trobe University Human Ethics Committee (HEC17-012), Australian Catholic University (2017-63R), Deakin University (2017-206) and the Victorian Department of Education and Training (2018_003616). Results will be disseminated through published manuscripts, conference presentations, public seminars and practical resources for stakeholder groups.

TRIAL REGISTRATION NUMBER

ACTRN12617000766314.

TRIAL SPONSOR

La Trobe University.

A Systematic Review and Meta-Analysis Examining the Effect of Exercise on Individuals With Intellectual Disability

This study examined the efficacy of exercise programs for individuals with intellectual disability (ID) based on experimental designs. Multiple databases were searched from inception up until March 2019. Randomized control trials were eligible for inclusion if they (a) included a population with ID; (b) used an exercise intervention; and (c) included performance, cardiovascular health, and/or psychological measures. All data were pooled using random effects models of standardized mean differences. The review included 18 studies which represented data from 799 individuals with ID. The largest effect was seen in relation to anxiety and depression symptoms (SMD = -3.07). This study represented the first comprehensive analysis on this topic area and illustrated that exercise can play an important therapeutic role for this population.

Physical Activity With Tailored mHealth Support for Individuals With Intellectual Disabilities: Protocol for a Randomized Controlled Trial

Background

Individuals with intellectual disabilities (IDs) have lower levels of physical activity (PA) and greater barriers for participation in fitness activities compared with members of the general population. As increased PA has positive effects on cardiovascular and psychosocial health, it is exceedingly important to identify effective interventions for use in everyday settings. Mobile health (mHealth) methods such as motion sensor games (exergames) and smartphone reminders for PA have been explored and found to be promising in individuals with IDs.

Objective

The purpose of this study is to examine the effectiveness of an individually tailored PA program with motivational mHealth support on daily levels of PA in youth and adults with IDs.

Methods

The trial uses a randomized controlled design comprising 30 intervention participants and 30 control group participants, aged 16 to 60 years, with sedentary lifestyles or low PA levels. While the controls will receive standard care, the intervention aims to increase the level of PA, measured as steps per day, as the primary outcome. Secondary outcome variables are body mass index, blood pressure, physical performance, social support for PA, self-efficacy in a PA setting, behavior problems, and goal attainment. The intervention involves the delivery of tailored mHealth support, using smartphones or tablets to create structure with focus on the communicative abilities of individual participants. Rewards and feedback are provided in order to motivate individuals to increase participation in PA. Participants in the intervention group, their close relatives, and care staff will be invited to participate in a preintervention goal-setting meeting, where goal attainment scaling will be used to select the participants’ PA goals for the intervention period. All participants will be assessed at baseline, at 3 months, and at 6 months.

Results

Enrollment was planned to start in April 2020 but will be delayed due to the pandemic situation. The main contribution of this paper is a detailed plan to run our study, which will produce new knowledge about tailored mHealth to support PA in individuals with intellectual disabilities.

Conclusions

We expect the new intervention to perform better than standard care in terms of improved PA, improved self-efficacy, and social support for activities. Technology offers new opportunities to promote healthy behaviors. The results of the study will determine the effectiveness and sustainability of a tailored mHealth support intervention to increase PA in youth and adults with IDs.

Trial Registration

ClinicalTrials.gov NCT04079439; https://clinicaltrials.gov/ct2/show/NCT04079439

International Registered Report Identifier (IRRID)

PRR1-10.2196/19213

Recruitment settings, delivery contexts, intervention techniques and outcomes of health promotion programmes for young adults with intellectual and developmental disabilities: A systematic review

BACKGROUND

People with intellectual and developmental disabilities (IDD) are at risk of developing long term health conditions, and a preventative health agenda research is emerging. However, little is known about the recruitment settings, delivery contexts, intervention techniques and outcomes of health promotion programmes for this population. Therefore, the aim of this review was to synthesize and evaluate these characteristics.

METHOD

A systematic review of studies identified from multiple databases on healthy lifestyle interventions for adolescents and young people with IDD was conducted. Data were synthesized and evaluated using a logic model. Quality of rigour was also assessed.

RESULTS

Sixteen geographically diverse studies were selected and evaluated. Participants were most commonly recruited from schools, with interventions typically taking place in a gym setting and involving physical activity training.

CONCLUSIONS

This review indicates that physical activity and dietary interventions in people with IDD may lead to lifestyle changes, however more robust evidence is required. Educational settings are conducive, with settings beyond schools requiring further consideration.

Individual and family-based approaches to increase physical activity in adolescents with intellectual and developmental disabilities: Rationale and design for an 18 month randomized trial

Adolescents with intellectual and developmental disabilities (IDD) are less physically active and have lower cardiovascular fitness compared with their typically developing peers. This population faces additional barriers to participation in moderate-to-vigorous physical activity (MVPA) such as reliance on parents, lack of peer-support, and lack of inclusive physical activity opportunities. Previous interventions to increase MVPA in adolescents with IDD have met with limited success, at least in part due to requiring parents to transport their adolescent to an exercise facility. We recently developed a remote system to deliver MVPA to groups of adolescents with IDD in their homes via video conferencing on a tablet computer. This approach eliminates the need for transportation and provides social interaction and support from both a health coach and other participants. We will conduct a 18-mo. trial (6 mos. active, 6 mos. maintenance, 6 mos. no-contact follow-up) to compare changes in objectively assessed MVPA in 114 adolescents with IDD randomized to a single level intervention delivered only to the adolescent (AO) or a multi-level intervention delivered to both the adolescent and a parent (A + P). Our primary aim is to compare increases in MVPA (min/d) between the AO and A + P groups from 0 to 6 mos. Secondarily we will compare changes in MVPA, sedentary time, cardiovascular fitness, muscular strength, motor ability, quality of life, and the percentage of adolescents achieving the US recommendation of 60 min. MVPA/d across 18 mos. We will also explore the influence of process variables/participant characteristics on changes in MVPA across 18 mos. NCT registration: NCT03684512.

Physical therapy in Down syndrome: systematic review and meta-analysis

BACKGROUND

Down syndrome is the most common chromosomal abnormality, with a worldwide incidence of around 0.1% in live births. It is related to several conditions in which the physical therapy could take action-preventing co-morbidities. This study aims to evaluate the effectiveness of physical therapy in Down syndrome, to know and compare the effectiveness of different physical therapy interventions in this population.

METHODS

A systematic review and a meta-analysis of randomised controlled trials were conducted. The search was performed during June 2018 in the following databases: PubMed, Web of Science, Physiotherapy Evidence Database and Scopus. The studies were selected using predefined inclusion and exclusion criteria. The Physiotherapy Evidence Database scale evaluated the quality of the methods used in the studies. Subsequently, the data were extracted, and statistical analysis was performed when possible.

RESULTS

A total of 27 articles were included, of which nine contributed information to the meta-analysis. Statistical analysis showed favourable results for the strength of upper and lower limbs [standardised mean difference (SMD) = 1.46; 95% confidence interval (CI): (0.77-2.15); and SMD = 2.04; 95% CI: (1.07-3.01)] and mediolateral oscillations of balance [SMD = -3.30; 95% CI: (-5.34 to -1.26)].

CONCLUSIONS

The results show the potential benefit of certain types of physical therapy interventions, specifically in strength and balance, in people with Down syndrome. There are still many aspects to clarify and new lines of research.

Progressive resistance training for persons with intellectual disabilities and visual impairment

BACKGROUND

Knowledge concerning the feasibility and effects of progressive resistance training (PRT) for persons with intellectual disabilities and visual impairment who are categorized in Gross Motor Function Classification System (GMFCS) Level 1 is limited. The aim of our study was to evaluate feasibility and effect of PRT on participants' Quadriceps strength and personal goals.

METHODS

Eight Participants followed a PRT program for 10 weeks. Feasibility was determined by percentage of attendance and compliance. The effect of PRT was analyzed with a linear mixed model (p < 0.05) and by normalized bootstrap (95% CI).

RESULTS

Participants attended 87.8% of the sessions and trained according to the PRT program, indicating sufficient compliance. Quadriceps strength increased significantly by 69%, and participants' personal goals were achieved.

CONCLUSION

PRT is a feasible and potentially effective method for increasing Quadriceps strength as well as achieving personal goals in persons with intellectual disabilities and visual impairment with GMFCS Level 1.

Is strength training feasible for young people with Prader-Willi syndrome? A phase I randomised controlled trial

OBJECTIVE

To investigate the feasibility of progressive resistance training for people with Prader-Willi syndrome (PWS), who have muscle weakness and very low muscle mass.

DESIGN

Randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis.

SETTING

Community gymnasium.

PARTICIPANTS

Sixteen participants with PWS (eight female; mean age 25 years) were randomly assigned with 1:1 allocation to an experimental (n=8) or control group (n=8).

INTERVENTION

Progressive resistance training was performed twice a week for 10 weeks. The training was supervised one-to-one by a physiotherapist and comprised seven exercises. The control group continued their usual activities and were offered the training after follow-up assessment.

MAIN OUTCOME MEASURES

Three domains of feasibility were evaluated: implementation (attendance and adherence), practicality (safety) and limited efficacy testing. Muscle strength (one repetition maximum for chest and leg press), physical function (box stacking test, timed stairs climb), muscle composition (US) and body composition (whole-body DXA scan) were measured before and after the intervention.

RESULTS

Participants attended 92% of scheduled sessions and adhered by progressing their training resistance by 82% (range 60-140%). There was one unexpected serious adverse event unrelated to the intervention and several non-serious expected adverse events related to the intervention. Estimates of standardised mean differences indicated moderate to large effects in favour of the experimental group for arm (0.92, 95%CI -0.11 to 1.95) and leg strength (0.78, 95%CI -0.27 to 1.83). The effect was uncertain for secondary outcomes.

CONCLUSIONS

There is preliminary evidence showing progressive resistance training is feasible for people with Prader-Willi syndrome and may increase muscle strength. Clinical Trial Registration Australia New Zealand Clinical Trials Registry ACTRN12616000107426.

Effectiveness of interventions to increase physical activity in individuals with intellectual disabilities: a systematic review of randomised controlled trials

BACKGROUND

People with intellectual disabilities (ID) often do not meet recommended guidelines for physical activity. The aim of this study was to systematically review available evidence that evaluated the effectiveness of interventions to increase physical activity in individuals with ID.

METHOD

Five electronic databases (MEDLINE, CINAHL, EMBASE, SPORTDiscus and Cochrane Central Register of Controlled Trials) were searched from inception of the database to July 2017 to identify randomised controlled trials that evaluated the effectiveness of interventions to improve physical activity among people with ID. Trials were included if they measured at least one objective measure of physical activity. Quality appraisal was completed by two independent reviewers using the Cochrane Risk of Bias Tool. The magnitude of treatment effect was estimated for each intervention by calculating the standardised mean difference (SMD) and associated 95% confidence interval.

RESULTS

Nine randomised controlled trials (976 participants, 501 women, age range 9 months to 83 years) were included. Four trials evaluated unimodal interventions and five trials evaluated multimodal health promotion programmes based on using supportive environments to enable sustained behavioural changes in physical activity. None of the trials were rated as low risk of bias as all had at least one item on the Cochrane Risk of Bias Tool that was considered to be high risk. No trials were able to implement participant blinding. Three trials found statistically significant beneficial effects of interventions for increasing physical activity. Results showed that a 10-week progressive resistance training programme led to maintenance of physical activity levels at 24 weeks in adolescents with Down syndrome (SMD 0.78, 95% CI 0.17 to 1.40). Additionally, a 12- to 16-month multicomponent diet and physical activity programme produced improvement in physical activity at programme completion in adults with ID (reported effect size of 0.29). Finally, an 8-month physical activity and fitness programme increased physical activity at 8 months in adults with ID (SMD 0.91, 95% CI 0.20 to 1.60). Findings regarding other interventions were inconclusive with small effects that were not statistically significant.

CONCLUSIONS

There is inconsistent evidence of the effects of interventions for improving physical activity levels in individuals with ID. A progressive resistance training programme was found to maintain physical activity levels in adolescents with Down syndrome, while a multicomponent diet and physical activity programme and a physical activity and fitness programme were found to improve physical activity levels in adults with ID. Future trials using rigorous research designs are required to confirm these findings and establish whether other interventions designed to increase physical activity in people with ID are effective.