Correlates of sedentary behaviour in youths with Down syndrome: the UP&DOWN study

Factors That Influence Physical Activity in Individuals With Down Syndrome: Perspectives of Guardians and Health Professionals

Identifying factors that influence physical activity (PA) among individuals with Down syndrome is essential for PA promotion. Insight can be gained from guardians and health professionals. The purpose of this study was to explore the perspectives of guardians and health professionals on facilitators and barriers of PA in individuals with Down syndrome. Interviews were conducted with 11 guardians (five mothers, four fathers, and two legal guardians) and 11 professionals (four PA specialists, three physical therapists, and four occupational therapists). Grounded theory was applied. Barriers and facilitators fit the levels of the ecological model of health behavior: (a) intrapersonal (perceived rewards), (b) interpersonal (interaction), (c) community (availability of programs), (d) organizational (school systems), and (e) policy (education). Guardians and professionals agreed on the importance of enjoyment, interaction, and programs to promote PA. Differences between groups were identified at the organizational and policy levels. PA in persons with Down syndrome is influenced by interactions between individual and environmental factors.

Analysis of Heart Rate, Perception of Physical Effort and Performance of Individuals with Down Syndrome Submitted to a Protocol of Virtual Games for Home-Based Telerehabilitation

Down syndrome (DS) is a genetic condition associated with impairments in several body systems, which may negatively influence the habit of practicing physical activities (PAs), increasing sedentary habits and the risk of comorbidities. Additionally, difficulty in accessing services, financial limitations and lack of interest may interfere with the practice of PAs. Considering the necessity of developing effective treatment alternatives, to increase the possibility of access and the interest of participants, we conducted a study using telerehabilitation with a virtual task to promote PA and analyze the motor performance of DS individuals. Our protocol consisted of 11 sessions of the virtual game called MoveHero. A total of 34 individuals with DS and 34 individuals with typical development participated in the study. Heart rate (HR) and rating of perceived effort (RPE) were collected at rest and during the game. Our results show that virtual reality presents a great possibility to promote PA and a way out of a sedentary lifestyle for DS individuals, considering the enhancement in HR and RPE found during the protocol for both groups. Moreover, our results show positive outcomes regarding motor performance, with significant improvement in the task with practice, demonstrating that individuals with DS are able to improve their motor proficiency with adequate stimuli in the virtual environment.

The Amount of Light to Vigorous Physical Activity (Met's-Hours/Day) in Children with and without Down Syndrome Attending Elementary School in Japan

Children with Down syndrome (DS) have physical characteristics such as hypotonus of the musculature. Therefore, their attainment rate of physical activity guidelines is low, and guidelines alone may not be sufficient in assessing the amount of physical activity in children with DS. Compared with normal children (NC) of the same grade, light physical activity (LPA) must be considered while assessing physical activity of children with DS, owing to muscle hypotonia. This study included 69 children with DS and 68 NC in grades 4−6 attending elementary school in Japan. The measurements for physical characteristics included age, height, weight, and body mass index. Physical activity was measured using a triaxial accelerometer, which indicated physical activity volume. Children with DS had less moderate-to-vigorous physical activity duration (DS: 53.1 min/day, NC: 65.0 min/day; p < 0.001) but significantly longer LPA duration (DS: 376.4 min/day, NC: 287.7 min/day; p < 0.001) than NC. Conversely, the amount of light to vigorous physical activity (Met’s-hours/day) was greater in children with DS (DS: 16.0 Met’s-hours/day, NC: 14.4 Met’s-hours/day; p = 0.037). In children with DS with muscular hypotonia, vigorous physical activity is challenging, but LPA is feasible. Developing and validating educational programs that promote physical activity with intensity level depending on individual’s physical characteristic are warranted.

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.

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.

Barriers and facilitators of physical activity in adolescents with intellectual disabilities: An analysis informed by the COM-B model

Background

Adolescents with intellectual disabilities are insufficiently physically active. Where interventions have been developed and delivered, these have had limited effectiveness, and often lack a theoretical underpinning.

Aim

Through application of the COM‐B model, our aim is to explore the factors influencing adolescent physical activity within schools.

Methods

A qualitative methodology, using focus groups with students who have mild/moderate intellectual disabilities, their parents'/carers' and teachers'. The COM‐B model provided the lens through which the data were collected and analysed.

Results

We identified of a range of individual, interpersonal, and environmental factors influencing physical activity, across all six COM‐B constructs, within the context of the ‘school‐system’.

Conclusion

This is the first study to use the COM‐B model to explore school‐based physical activity behaviour, for adolescents with intellectual disabilities. Identification of such physical activity behavioural determinants can support the development of effective and sustainable interventions.

Physical activity levels of children and adolescents with intellectual disabilities in Northern China

BACKGROUND

Limited research has looked at the physical activity (PA) among Chinese children and adolescents with intellectual disabilities.

METHODS

The Children's Leisure Activities Study Survey-Chinese version was applied in evaluating PA levels among children and adolescents with intellectual disabilities.

RESULTS

The data indicated that only 29.5% of children and adolescents with intellectual disabilities met the PA recommendation. Boys engaged in significantly more MVPA and had higher energy expenditure than girls during weekdays and the whole week. The general trend in PA levels demonstrated a downtrend with the growth of age of children and adolescents with intellectual disabilities. The students aged 6-12 years old performed more MVPA and had greater energy expenditure compared with those 13-15 and 16-18 years old.

CONCLUSION

The level of PA among Chinese children and youths with intellectual disabilities is remarkably low, and there is a large gap compared with the PA recommendation.

Is Physical Activity-Related Self-Efficacy Associated with Moderate to Vigorous Physical Activity and Sedentary Behaviour among Ambulatory Children with Cerebral Palsy?

Purpose: To determine how physical activity-related self-efficacy is associated with physical activity and sedentary behaviour time among ambulatory children with cerebral palsy (CP). Method: Children with CP, Gross Motor Function Classification System (GMFCS) Levels I-III ( N = 26; aged 9–18 y), completed the task self-efficacy component of a self-efficacy scale and wore Actigraph GT3X+ accelerometers for 5 days. Correlations (Pearson and Spearman’s rank-order; a = 0.050) were conducted to evaluate the relationships among age, GMFCS level, self-efficacy, and both daily moderate-to-vigorous physical activity (MVPA) and sedentary time. Linear regression models were used to determine the relationships among the independent variables and MVPA and sedentary time. Results: Self-efficacy was positively associated with MVPA time ( r = 0.428, p = 0.015) and negatively correlated with sedentary time ( r = –0.332, p = 0.049). In our linear regression models, gross motor function (β = –0.462, p = 0.006), age (β = –0.344, p = 0.033), and self-efficacy (β = 0.281, p = 0.080) were associated with MVPA time ( R2 = 0.508), while GMFCS level (β = 0.439, p = 0.003) and age (β = 0.605, p < 0.001) were associated with sedentary time ( R2 = 0.584). Conclusions: This research suggests that self-efficacy, age, and gross motor function are associated with MVPA in children with CP. Additional research is needed to confirm these findings and further explore the influence of self-efficacy on sedentary behaviour.

The association between obesity and sedentary behavior or daily physical activity among children with Down's syndrome aged 7-12 years in Japan: A cross-sectional study

Background

An assessment of the adverse health effects of obesity in children with Down's syndrome (DS) is required to develop programs that facilitate the acquisition of healthy behaviors. Individuals with DS are often obese. These individuals must develop health related behaviors in childhood. For this reason, it is necessary to clarify the factors associated with obesity in children with DS.

Aims

This study had two purposes. The first was to assess the obesity and to evaluate the sedentary behavior (SB) and physical activity of Japanese elementary school children with Down's syndrome. The second was to investigate the association between obesity and SB or moderate to vigorous physical activity (MVPA).

Methods and procedures

Ninety-three children (male/female: 51/42) with DS in elementary school grades 1 to 6 (aged 7–12 years) participated in this study in Japan. Physical characteristics were obtained from the questionnaire completed by their parents. The questionnaire provided information on regular school checkups. SB and MVPA were evaluated using a triaxial accelerometer.

Results

Approximately 20% of the children with DS were obese. Nearly half of the children with DS achieved 60 min of MVPA. SB time was significantly longer in the upper grades (aged 11–12 years) than in the lower grades (aged 7–8 years). Comparing weekdays and weekend days, the middle (aged 9–10 years) and upper grades had significantly shorter MVPA times on weekend days. The frequency of obesity was significantly associated with shorter MVPA times in the lower grades and longer SB time in the middle grades.

Conclusions and implications

Children with DS may increase their SB time as their age group (grade category) increases. Increasing opportunities for MVPA during weekends may increase physical activity. The observed relationship between obesity and SB time or MVPA time may apply only to younger and middle grade children with DS. Further investigation is necessary to confirm these relationships.

Bidirectional longitudinal associations of fatness with physical fitness in adolescents with Down syndrome. The UP&DOWN Longitudinal study

BACKGROUND

The aim of this study was to examine the bidirectional longitudinal associations of several markers of fatness and physical fitness in adolescents with Down syndrome.

METHODS

This study comprised a total of 111 adolescents (41 females), aged from 11 to 20 years with complete data at the baseline. We had a drop-out of <10% from the baseline to the 2-year follow-up. The ALPHA health-related fitness test battery for youth was used.

RESULTS

Our results show that all fatness variables at the baseline were associated with a 2-year change in cardiorespiratory fitness (β ranging from -0.32 to -0.38; all p < .05), but not with muscular and motor fitness (p > .05). However, no associations were found between physical fitness components as predictors and fatness indicators (p > .05).

CONCLUSIONS

Results suggest that reducing fatness during adolescence might represent a modifiable factor to improve cardiorespiratory fitness at the 2-year follow-up, but not vice versa since associations were not bidirectional.

Systematic review of sedentary behaviour in people with Down syndrome across the lifespan: A clarion call

BACKGROUND

Individuals with Down syndrome (DS) experience health disparities possibly associated with high levels of sedentary behaviour (SB). We systematically reviewed SB measurement, levels, patterns, correlates, consequences and interventions in people with DS across the lifespan.

METHOD

We searched these databases: Embase; PubMed; Web of Science; Scopus; CINAHL; PsycINFO; SPORTDiscus; and Cochrane Library. We included quantitative studies published in English since 1 January 1990.

RESULTS

We identified 17 eligible articles. Across studies, accelerometer-determined sedentary time was 552 min/day (median: 542; range 392-680 min/day). Sedentary time appeared higher than previously reported values in the general population, especially for youth with DS. Multivariate SB correlates were primarily familial and environmental. Sedentary behaviour consequences have not been exclusively studied. Motor skills training reduced SB in youth with DS.

CONCLUSIONS

Sedentary behaviour research in this population is in early stages. Individuals with DS have high levels of SB that may be responsive to interventions.

Down syndrome, Alzheimer disease, and cerebral amyloid angiopathy: The complex triangle of brain amyloidosis

Down syndrome (DS) is the main genetic cause of intellectual disability worldwide. The overexpression of the Amyloid Precursor Protein, present in chromosome 21, leads to β-amyloid deposition that results in Alzheimer disease (AD) and, in most cases, also to cerebral amyloid angiopathy (CAA) neuropathology. People with DS invariably develop the neuropathological hallmarks of AD at the age of 40, and they are at an ultra high risk for suffering AD-related cognitive impairment thereafter. In the general population, cerebrovascular disease is a significant contributor to AD-related cognitive impairment, while in DS remains understudied. This review describes the current knowledge on cerebrovascular disease in DS and reviews the potential biomarkers that could be useful in the future studies, focusing on CAA. We also discuss available evidence on sporadic AD or other genetically determined forms of AD. We highlight the urgent need of large biomarker-characterized cohorts, including neuropathological correlations, to study the exact contribution of CAA and related vascular factors that play a role in cognition and occur with aging, their characterization and interrelationships. DS represents a unique context in which to perform these studies as this population is relatively protected from some conventional vascular risk factors and they develop significant CAA, DS represents a particular atheroma-free model to study AD-related vascular pathologies. Only deepening on these underlying mechanisms, new preventive and therapeutic strategies could be designed to improve the quality of life of this population and their caregivers and lead to new avenues of treatment also in the general AD population.

Patterns of sedentary time and ambulatory physical activity in a Danish population of girls and women with Rett syndrome

BACKGROUND

Rett syndrome (RTT) is a rare neurodevelopmental disorder leading to multiple disabilities and high dependency on caregivers. This study aimed to: (1) describe the patterns of sedentary time and daily steps and (2) identify the association of individual and environmental characteristics with sedentary time.

METHODS

All Danish females with RTT older than 5 years of age and with a MECP2 mutation were invited to participate. The activPAL and StepWatch Activity Monitor (SAM) were worn by participants for at least four days. Sedentary time and step counts were plotted by time to examine daily activity patterns. Associations between sedentary time and individual and environmental covariates were assessed with linear regression models.

RESULTS

The median (interquartile range) age of participants was 22.0 (14.3-36.5) years. On average 83.3% (standard deviation 13.9%) of waking hours were spent in sedentary behaviours (n = 48) and the median (interquartile range) daily step count was 5128 (2829-7704) (n = 28). Females older than 33.5 years, and those unable to walk independently were more sedentary.

CONCLUSIONS

This study demonstrated high levels of sedentary time and low daily step counts in a Danish population of females with RTT. Advancing age and lower walking skills were associated with higher levels of sedentary time. Implications for Rehabilitation Sedentary lifestyles in individuals with disabilities have a negative impact on health and quality of life. High levels of sedentary time and low daily step counts were demonstrated in a Danish population of females with Rett syndrome. Advancing age and inability to walk independently were strongly associated with higher levels of sedentary time in females with Rett syndrome. Understanding patterns of sedentary behaviour and physical activity can aid health care professionals in developing health-promoting physical activity interventions.