Health-related physical fitness in children and adolescents with Down syndrome and response to training

Swim, Strength, or Combined Programs: Effect on Health-Related Physical Fitness in Adolescents With Down Syndrome

The adolescent population with Down syndrome (DS) appears to show higher levels of body fat and lower levels of cardiorespiratory fitness or muscle strength than their peers without disabilities. There is a need to create physical activity programs to improve these data. The aim of this research was to determine the effects of a 16-week swimming program, strength program, and combined program (swimming and strength training) on body composition and health-related physical fitness on adolescents with DS and to assess whether there are differences in the results of the different training programs. Forty-five adolescents (17 female and 28 male; average age 15.5 [1.53] years) with DS were recruited and randomized to three groups (swim [n = 15], strength [n = 15], and combined [n = 15]). Results showed that the swim group had significant improvements in all health-related physical fitness variables and there was an improvement in some body-composition variables (p < .05). The strength and combined groups obtained minor improvements in the variables analyzed. In summary, a 16-week swim program consisting of three sessions of 60 min is able to improve levels of body composition and health-related physical fitness in adolescents with DS. The swim training program seems to be more effective in improving body composition and health-related physical fitness than the strength or combined program. These findings could be useful in different special-education centers due to the predisposition shown by the population with DS to this sport modality.

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.

A slightly adapted treadmill protocol for the determination of maximal oxygen uptake in adults with Down syndrome

INTRODUCTION

The VO2 max test is the gold standard measure for aerobic fitness. A standardised treadmill protocol was developed years ago for individuals with Down syndrome but with variations in terms of starting speed, load increases and time spent at each stage. However, we realised that the most widely used protocol for adults with Down syndrome, trouble participants with high treadmill speeds. Consequently, the purpose of the current study was to determine whether an adapted protocol provided improved maximal test performance.

METHOD

Twelve adults (33 ± 6 years) randomly performed two variations of the standardised treadmill test.

RESULTS

The protocol that added another incremental incline stage increase yielded a significant improvement in absolute and relative VO2 peak, time to exhaustion, minute ventilation and heart rate max.

CONCLUSION

A treadmill protocol with the addition of an incremental incline stage allowed for a significant improvement in maximal test performance.

Evaluation of Skinfold Techniques in People with Down Syndrome: Development of a New Equation

The primary aim of this study was to evaluate the accuracy of skinfold thickness (SFT) measurements for the estimation of %Fat when compared to dual energy X-ray absorptiometry (DXA) in individuals with Down syndrome (DS). The secondary aim was to develop a new SFT-based body fat equation (SFT_NICKERSON). SFT-based %Fat was estimated using a body fat equation from González-Agüero (SFT_G-A) and body density conversion formulas from Siri (SFT_SIRI) and Brozek (SFT_BROZEK). Criterion %Fat was measured via DXA. SFT_G-A, SFT_SIRI, and SFT_BROZEK were significantly lower than DXA (mean differences ranged from -7.59 to -13.51%; all p < 0.001). The SEE values ranged from 3.47% (SFT_BROZEK) to 8.60% (SFT_G-A). The 95% limits of agreement were greater than ±10% for all comparisons. Mid-axilla and suprailium were significant predictors of %Fat (both p < 0.05). %Fat SFT_NICKERSON = 10.323 + (0.661 × mid-axilla) + (0.712 × suprailium). Age and all other skinfold sites were not statically significant in the regression model (all p > 0.05). Current findings indicate that SFT_G-A, SFT_SIRI, and SFT_BROZEK erroneously place an individual with excessive adiposity in a normal healthy range. Accordingly, the current study developed a new equation (SFT_NICKERSON) that can easily be administered in people with DS in a quick and efficient time frame. However, further research is warranted in this area.

Swimmers with Down Syndrome Are Healthier and Physically Fit than Their Untrained Peers

While there are positive benefits from physical activity participation for individuals with Down syndrome, little is known about the effects of swimming training. The aim of this study was to compare the body composition and physical fitness profile of competitive swimmers and moderately active (untrained) individuals with Down syndrome. The Eurofit Special test was applied to a group of competitive swimmers (n = 18) and a group of untrained individuals (n = 19), all with Down syndrome. In addition, measurements were taken to determine body composition characteristics. The results showed differences between swimmers and untrained subjects in height, sum of the four skinfolds, body fat %, fat mass index and all items of the Eurofit Special test. Swimmers with Down syndrome exhibited physical fitness levels near to the Eurofit standards, although lower fitness levels were attained by these persons when compared to athletes with intellectual disability. It can be concluded that the practice of competitive swimming seems to counteract the tendency for obesity in persons with Down syndrome and also helps to increase strength, speed and balance.

The Effectiveness of Computer Aided Video Modeling in Teaching Basic Basketball Movements to Individuals with Down Syndrome

In this study, the effectiveness of the video modeling method in teaching basic basketball skills to students with Down syndrome was examined. Four students with Down syndrome, who were studying at the disability free living center in Dolayaba, participated in this study. The ages of the students diagnosed with Down syndrome were as follows: two of them were 13, the others were 14 and 16. In the study, the effectiveness of video modeling in teaching basic basketball skills was evaluated using the multiple probe model, one of the single-subject research methods. The experimental process of the study consisted of collecting baseline data, daily, conducting instructional sessions, maintenance and generalization stages. The findings of the study showed that video modeling was effective in teaching basic basketball skills to students with Down syndrome and that they maintained the skills in interpersonal and environmental differences after the end of the instruction. When the opinions of the basketball teacher and the students were evaluated, it was determined that the students' self-confidence and peer relations were strengthened thanks to their active participation in the lessons. The students were not bored because they stated that they found the lessons interesting and fun.

Strength versus aerobic program: effects on body composition and health-related physical fitness levels of youths with Down syndrome

Aims: To determine the effect of a 16-week fitness program (strength vs. aerobic) on different indicators of body composition and components of health-related physical fitness in youths with Down syndrome. Methods and procedures outcomes: Fifty adolescents (19 girls and 31 boys; average age, 18.33 ± 1.42 years) with Down syndrome were recruited and randomized to two groups (strength group vs. aerobic group). Adolescents allocated in the aerobic group carried out a physical activity program three times a week for 16 weeks meanwhile adolescents allocated in the strength group performed a fitness program three times a week for 16 weeks. Results: The exercise group had significant improvements in all health-related physical fitness variables (p < .05) but not on body composition. Conclusions and implications: A sixteen week fitness program consisting of three sessions of 60 min is able to increase levels of health-related physical fitness but not on body composition in youths with Down syndrome. The aerobic program does not seem to show significant differences.

Nutrition as Prevention of Diet-Related Diseases-A Cross-Sectional Study among Children and Young Adults with Down Syndrome

BACKGROUND

The aim of this study was to assess the diet of children with Down syndrome (DS) and to identify potential dietary mistakes made by their parents.

MATERIALS AND METHODS

The study was conducted among 195 parents of people with DS between November 2020 and March 2021. Data for the study were collected anonymously using the CAWI method.

RESULTS

122 (62.6%) people with DS did not eliminate any nutrient from their diet. By contrast, in the study group, the following numbers of people reported the following dietary restrictions: 51 (26.2%) gluten, 56 (28.7%) lactose, 17 (8.7%) casein, 26 (13.3%) sucrose, 2 (1.0%) histamine, 2 (1.0%) lectins, and 1 (0.5%) dairy. The most frequent response for vegetable and fruit consumption was once a day, with 83 (42.6%) and 87 (44.6%) parents indicating this. The most frequent response for dairy product consumption was every day, with 72 (36.9%) parents indicating this, while 36 (20%) parents stated that their children do not eat dairy products at all. In the study group, the most frequent response for meat consumption was several times a week, this was indicated by 107 (54.9%) parents, while 1 (0.5%) of them said that their children do not eat meat products at all. The most frequent response for fish consumption was 1-2 times a week, this answer was indicated by 101 (51.8%) parents, while 13 (6.7%) said that their children do not eat these products at all.

CONCLUSIONS

A majority of the subjects with DS are usually fed in a normal way, but nutritional mistakes are made by the parents. Special attention should be paid to prolonging the period of natural feeding.

Effects of 24-week basketball programme on body composition and functional fitness on adults with Down syndrome

BACKGROUND

The body index [body mass, body mass index (BMI), waist circumference and waist-height ratio] and functional fitness (aerobic capacity, muscular strength, balance, flexibility and functional ability) of people with Down syndrome (DS) are substantially lower than those in the general population, as DS has an overall negative impact on health.

AIMS

This study explored the effect of a 24-week basketball training programme on the body composition and functional fitness of adults with DS.

METHODS AND PROCEDURE OUTCOMES

Twenty-two adults with DS (24 ± 6 years; 25 ± 4 kg/m² ) were randomly allocated to the experimental (n = 11, 67.04 kg) and control groups (n = 11, 69.36 kg). The experimental group performed 24 weeks of basketball programme training (3 times per week, 60 min per session), while the control group maintained their daily activities without any special physical training. Body composition and functional fitness parameters were measured before and after the intervention. To evaluate the differences between groups, an analysis of covariance (ANCOVA) was used while controlling for differences at baseline.

RESULTS

Hip circumference and waist-height ratio were statistically different at baseline between the intervention and control groups. After the 24-week basketball training programme, the results showed significant differences between the exercise and control groups for hip circumference, body mass, BMI, waist circumference, hip circumference, waist-height ratio, flexibility, aerobic capacity, static and dynamic balance, balance and basketball functional ability (P < 0.05). The exercise group showed significant improvements in all variables of body composition and functional fitness (P < 0.05) except for the waist-hip ratio. There was no statistical significance between all physical composition and functional health variables in the control group except for the standing long jump (P > 0.05), with effect sizes ranging from small to large.

CONCLUSIONS AND IMPLICATIONS

The basketball training programme improved body composition and functional fitness of adults with DS.

Assessment of the Correlation between the Levels of Physical Activity and Technology Usage among Children with Down Syndrome in the Riyadh Region

Background: Children with Down Syndrome (C-DS) have language, cognitive and communication difficulties, in addition to consistent physical inactivity that contributes to poor health and higher-disability-adjusted life years. The purpose of this study was to determine the correlation between the use of electronic technology and levels of physical activity in C-DS in the Riyadh region of Saudi Arabia. Methods: A cross-sectional study was conducted with 49 mothers, where each had a child (6-12 years of age) with Down Syndrome (DS), and who were recruited using purposive sampling from three DS centers in Riyadh, Saudi Arabia. The Children's Physical Activity Questionnaire and Research Questionnaire on the Impact of Technology on Children were used. Descriptive statistics were used to describe the demographics. Pearson's correlation, Student's t-test and the Chi-square test were used to assess the association between technology use, physical activity levels and socio-demographic variables. Results: There was no significant correlation between physical activity and the use of technology by C-DS. However, there was a negative correlation between a high level of physical activity and technology use (R = -0.037). Although, no significant correlation between the mother's characteristics and technology use was found; there was a significantly positive correlation (p = 0.05) between the education level of mothers and the technology use by C-DS. Nonetheless, there was no association between the physical activity level and the gender of the child with DS. Conclusions: This study found that no significant relationship exists between the use of electronic gadgets and the level of physical activity in C-DS.

Motor Coordination and Global Development in Subjects with Down Syndrome: The Influence of Physical Activity

Background: Many research studies have investigated motor impairments and delayed development in children with Down Syndrome (DS). However, very few studies detected these features in adults with DS. Hence, this study aimed to investigate the relationship between motor coordination and global development in subjects with DS, including adults. Furthermore, the second aim was to detect any differences in motor coordination and global development as a function of the practice of physical activity (PA) in this population. Methods: Twenty-five participants with DS (10 f, 15 m), with a chronological mean age of 27.24 years and development mean age of cognitive area of 4.93 years, were enrolled and divided into a physically active group (PA-G; n = 15) and a physically inactive group (PI-G; n = 10). All participants performed the Movement Assessment Battery for Children (M-ABC) to assess fine and gross motor skills, while the Developmental Profile 3 (DP-3) checklist was administered to the parents in order to screen strengths and weaknesses of five developmental areas of their relatives with DS. Results: Our results showed positive correlations between the following variables: global motor coordination and global development, global motor coordination and adaptive behavior development area, aiming and catching skills and global development, aiming and catching skills and adaptive behavior development area. As for the practice of PA, PA-G showed higher scores than PI-G in all the tasks of both the M-ABC and the DP-3, though significant differences were found only for the global motor coordination, for the aiming and catching skills, as well as for the physical development area. Conclusions: The findings of this study reinforce the need to implement and encourage the practice of PA in order to promote well-being and social inclusion in subjects with DS.

A Pilot Dance Intervention to Encourage Physical Activity Engagement for Adolescent Girls with Intellectual Disabilities

Adolescent girls with intellectual disabilities (ID) are at risk for low physical activity (PA) participation due to their limited opportunities. Purpose: To evaluate the feasibility and preliminary efficacy of a 12-week dance intervention to promote engagement in moderate-to-vigorous PA (MVPA) and increase cardiorespiratory fitness. Methods: The 12-week intervention included two 75-min weekly dance sessions. Continuous heart-rate (HR) monitoring assessed time spent below/at/above each girl’s target HR zone. Cardiorespiratory fitness was measured by the 6-min walk test (6MWT). Survey items assessed participant enjoyment and participant and parent satisfaction. Results: The mean (SD) age of 18 adolescent girls was 17.3 (2.7) years. Overall, girls attended 88% of sessions and spent 52.3% of each session in MVPA. Mean MVPA was unchanged across the 12 weeks, but the pattern differed across the three sites. We observed a non-significant pre-post increase of 74.6 feet on the 6MWT. Post-intervention surveys indicated that most girls liked the program, perceived improved fitness, and wished to continue dancing. The majority also reported a preference for a girls-only dance program exclusively for those with ID. Conclusion: Our findings suggest that dance is viable for promoting PA for girls with ID. More frequent exercise training is likely needed to improve cardiorespiratory fitness.

Dohsa-hou training improves bimanual coordination among children with Down Syndrome

A child with Down syndrome (DS) is physically characterized by muscle hypotonia, joint instability, and poor motor coordination. Here, we tested whether Dohsa-hou training could improve motor coordination among children with DS, compared to a control condition. Forty children with DS were randomly assigned either to Dohsa-hou training or to a control condition. All participants completed a bimanual coordination test, at the following time points: baseline, seven weeks later at completion of the intervention, and again 4 weeks later at follow-up. Bimanual coordination accuracy and consistency improved from baseline to intervention completion and to follow-up, but only in the Dohsa-hou training, compared to the control group. The findings suggest that among children with DS and compared to a control condition, Dohsa-hou training has the potential to enhance the bimanual coordination, thus contributing to improved motor control of children with DS.

Cardiovascular Physiology and Pathophysiology in Down Syndrome

Down Syndrome (Ds) is the most common chromosomal cause of intellectual disability that results from triplication of chromosome 21 genes. Individuals with Ds demonstrate cognitive deficits in addition to comorbidities including cardiac defects, pulmonary arterial hypertension (PAH), low blood pressure (BP), and differences in autonomic regulation. Many individuals with Ds are born with heart malformations and some can be surgically corrected. Lower BP at rest and in response to exercise and other stressors are a prevalent feature in Ds. These reduced cardiovascular responses may be due to underlying autonomic dysfunction and have been implicated in lower exercise/work capacity in Ds, which is an important correlate of morbidity, mortality and quality of life. Exercise therapy can be beneficial to normalize autonomic function and may help prevent the development of co-morbidities in Ds. We will review cardiovascular physiology and pathophysiology in individuals with Ds, along with exercise therapy and special considerations for these individuals.

Effectiveness of Swimming Program in Adolescents with Down Syndrome

The aim of this study was to estimate the influence of a 33-week swimming program on aerobic capacity, muscle strength, balance, flexibility, and body composition of adolescents with Down syndrome (DS). Twenty-two adolescents diagnosed with DS were randomly allocated into the training group (T) and the control group (C). The T group participated in 33 weeks of water-based exercise and a swimming program while the control group maintained their normal daily activity. Following thirty-three weeks of swimming program, body mass, body fat, and BMI of the T group decreased significantly (from 56.8 ± 7.97 kg to 55.0 ± 7.11 kg, from 15.1 ± 4.47 kg to 13.2 ± 3.92 kg, and from 25.1 ± 2.37 to 24.0 ± 2.05, respectively) while a significant increase was recorded in C (from 57.3 ± 8.43 kg to 59.7 ± 8.29 kg, from 14.5 ± 2.76 kg to 16.0 ± 3.11 kg, and from 25.4 ± 2.46 to 26.0 ± 2.72, respectively). Moreover, significant improvement in aerobic capacity in the T group was noted; VO₂max (mL/kg/min) increased by 16.3% in T and decreased by 4.8% in C. Improvement in static arm strength, trunk strength and endurance/functional strength were noted in T, while the parameters did not change in C. The speed of arm movement, balance and flexibility did not change following the intervention. Also, the aquatic skills improved significantly in the training group. Changes in C were not significant. The results of our study indicate that 33-week swimming program significantly improved health status and swimming skills in adolescents with DS.

Prospective Associations of Physical Activity and Health-Related Physical Fitness in Adolescents with Down Syndrome: The UP&DOWN Longitudinal Study

(1) Background: Numerous studies have focused on examining the association between PA levels and health-related physical fitness components in children or adolescents without disabilities. However, research on the association between PA and health-related physical fitness in adolescents with DS (Down syndrome) is limited, and most of the previous studies have been developed with a cross-sectional perspective. Therefore, the aim of the present study was to assess the prospective association of accelerometer-based PA at baseline with health-related physical fitness at a 2-year follow-up in a relatively large sample of adolescents with DS from the UP&DOWN study. (2) Methods: A total of 92 adolescents with DS (58 males) between 11 and 20 years old with full data were eligible from an initial sample of 110 participants. Fitness was assessed by the ALPHA health-related fitness test battery for youth, and physical activity was assessed by Actigraph accelerometers. (3) Results: The high tertile of total PA was related to decreased motor (Beta [95% CI] = −1.46 [−2.88; −0.05]) and cardiorespiratory fitness (Beta [95% CI] = −2.22 [−4.42; 0.02]) in adolescents with DS. (4) Conclusions: In adolescents with DS, (i) PA level was not prospectively associated with muscular fitness and (ii) high levels of total PA at the baseline were inversely associated with motor and cardiorespiratory fitness at the 2-year follow-up. For comparative purposes, these relationships were also examined in a subsample of adolescents without DS.

Effect of virtual reality therapy, combined with physiotherapy for improving motor proficiency in individuals with Down syndrome: A systematic review

Background

Individuals with Down syndrome may struggle with anticipatory postural adjustments, and adapt slower to motor tasks and environmental changes, due to decreased motor proficiency.

Objectives

To determine the effectiveness of virtual reality therapy (VRT), specifically Nintendo Wii, combined with physiotherapy or occupational therapy (OT) for improving motor proficiency in individuals with Down syndrome, compared to standard physiotherapy, OT or no intervention.

Method

Nine computerised databases were searched from inception to July 2020. Methodological quality of randomised controlled trials and quasi-experimental studies was appraised using the physiotherapy evidence database (PEDro) scale and the Joanna Briggs Institute Critical Appraisal Checklist for Case Reports.

Results

Two randomised controlled trials and four quasi-experimental studies were included, with an average PEDro score of 7.3. One included case study scored 5. This review included 345 participants. Motor proficiency includes balance, coordination, strength and agility. Agility showed a significant improvement after 5 (p = 0.01) or 24 (p < 0.01) weeks. Strength showed a significant improvement after a 6- (p = 0.000) or 24-week intervention (p < 0.05). Balance showed inconclusive results for adults, and significant improvement in children after 6 (p = 0.000), 8 (p < 0.05) or 24 (p < 0.003) weeks. One study (n = 155) showed that upper limb and bilateral coordination improved significantly after 24 weeks (p < 0.003).

Conclusion

Level II, III-1 and IV evidence suggested that VRT may be valuable to improve agility and strength in individuals with Down syndrome, and balance and coordination in children with Down syndrome.

Clinical implications

It may be beneficial to use VRT in addition to standard physiotherapy or OT interventions for improving motor proficiency in individuals with Down syndrome.

Impact of two different pulmonary rehabilitation methods in children with down syndrome

PURPOSE

To investigate and compare the effect of proprioceptive neuromuscular facilitation of respiratory muscles with that of inspiratory muscle training as a preventive measure on respiratory muscle strength, chest expansion, spirometry, and functional capacity in children with Down syndrome.

METHODS

Forty-five Down syndrome participants with an age ranged from 10 to 13 years were enrolled. There were distributed into three groups. The study group A (n = 15) underwent proprioceptive neuromuscular facilitation of respiratory muscles while study group B (n = 15) underwent inspiratory muscle training. Third group C (n = 15) was a control group. The three groups received aerobic exercises using the bicycle ergometer for 20 min, 5 times/week for 12 successive weeks. The treatment program for both study groups was conducted for 20-30 min, 5 times/week for 12 successive weeks. Measurements of respiratory muscle strength (MIP, MEP), chest expansion, spirometry test (VC, FEV1, PEFR, MVV) and 6 min walk test were measured pre and post treatment.

RESULTS

The post treatment mean values of all investigated variables were significantly increased in both study groups with higher effect to group underwent proprioceptive neuromuscular facilitation of respiratory muscles.

CONCLUSION

Both proprioceptive neuromuscular facilitation of respiratory muscles and inspiratory muscle training are effective in children with Down syndrome on improving respiratory muscle strength, chest expansion, spirometry and functional capacity with superior effect of proprioceptive neuromuscular facilitation.

Active Parents-Active Children-A Study among Families with Children and Adolescents with Down Syndrome

From a public health perspective, it is important that children with Down syndrome (DS) lay the foundations of physical activity (PA) early in life to keep active in school, as teenagers and as adults. The aims were to investigate PA patterns in children and adolescents with DS, as well as their parents’ and siblings’ PA patterns. Methods: A survey was performed among 310 families with children with DS (54% boys and 46% girls) aged 8–18 years (mean 14.04, SD 3.18) in Sweden. Chi-squared tests and multiple logistic regression were carried out. Results: Nineteen percent of children and adolescents with DS and 34% of the parents were active three or more times per week. The child’s PA level was significantly associated with parents’ PA (OR = 5.5), siblings’ PA (OR = 5.1) and the child’s locomotion ability (OR = 3.5). Physically active parents had active children to a greater extent than inactive parents (59% vs. 29%; p < 0.001). Conclusions: Physically active parents have active children. To promote PA among children and adolescents with DS, it is important to promote and pay attention to the parents’ and siblings’ PA behavior, as children with DS are dependent on support from the family.

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.

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.

Safety, feasibility and efficacy of side-alternating vibration therapy on bone and muscle health in children and adolescents with musculoskeletal disorders: A pilot trial

AIMS

A pilot study was performed to establish the safety, feasibility and efficacy of vibration therapy (VT) on bone and muscle health in children and adolescents with a range of musculoskeletal disorders.

METHODS

Seventeen participants (15.7 years ± 2.9 years), with conditions that impacted on their musculoskeletal health, completed 20 weeks of side-alternating VT for 9 min/session, 4 times/week at 20 Hz. Data were collected at baseline and after 20 weeks of intervention. Assessments included whole-body dual-energyX-ray absorptiometry, muscle function (force plate) and 6-min walk test.

RESULTS

Compliance with the prescribed VT training protocol was relatively high overall at 78% and there were no adverse events reported. After 20 weeks intervention, functional assessments showed time taken to perform the chair test was reduced by 15% (P = 0.018), leg balance improved with standard ellipse area decreasing by 88% (P = 0.006) and distance walked in the 6-min walk test improved by 9% (P = 0.002). Participants displayed increased total body mass (1.94 kg; P = 0.018) with increased lean mass (1.20 kg; P = 0.019) but not fat mass (P = 0.19). There was no change in total body bone mineral density (P = 0.44) or bone mineral content (P = 0.07).

CONCLUSIONS

Twenty weeks of side-alternating VT was a feasible protocol that was associated with improvements in physical function and no detrimental effects on lean mass, bone mass or density in children and adolescents with musculoskeletal disorders.

Skeletal dynamics of Down syndrome: A developing perspective

Individuals with Down syndrome (DS) display distinctive skeletal morphology compared to the general population, but disparate descriptions, methodologies, analyses, and populations sampled have led to diverging conclusions about this unique skeletal phenotype. As individuals with DS are living longer, they may be at a higher risk of aging disorders such as osteoporosis and increased fracture risk. Sexual dimorphism has been suggested between males and females with DS in which males, not females, experience an earlier decline in bone mineral density (BMD). Unfortunately, studies focusing on skeletal health related to Trisomy 21 (Ts21) are few in number and often too underpowered to answer questions about skeletal development, resultant osteoporosis, and sexual dimorphism, especially in stages of bone accrual. Further confounding the field are the varied methods of bone imaging, analysis, and data interpretation. This review takes a critical look at the current knowledge of DS skeletal phenotypes, both from human and mouse studies, and presents knowledge gaps that need to be addressed, differences in research methodologies and analyses that affect the interpretation of results, and proposes guidelines for overcoming obstacles to understand skeletal traits associated with DS. By examining our current knowledge of bone in individuals with Ts21, a trajectory for future studies may be established to provide meaningful solutions for understanding the development of and improving skeletal structures in individuals with and without DS.

[Exercise as medicine in chronic diseases during childhood and adolescence]

Physical activity (PA) and exercise improve the overall quality of life, as well as prevent the onset of diseases in healthy children and adolescents, and as an aid to treat prevalent chronic diseases in childhood. PA and exercise are like medicine, but sedentary lifestyle and inactivity cause disease. In this article, the existing scientific evidence in this field is reviewed and recommendations for professionals involved in child health are updated. A good knowledge of how to prescribe exercise and PA in paediatrics in different diseases is necessary. Interventions to avoid inactivity of children and adolescents must be supported by the appropriate increase in the level of PA, through integration and training programs, which achieve both an overall improvement of the neuromuscular physical condition and also physical, cognitive, and psychosocial performance. The Health Promotion Committee of Spanish Paediatric Association proposes strategies that help to obtain this objective, aiming to improve the health of our patients through the practice of exercise and the increase in PA.

The effect of aquatic exercises on the physical and functional fitness of adults with Down syndrome: A non-randomised controlled trial

BACKGROUND

The importance of exercise for individuals with Down syndrome (DS) has been well documented. The use of aquatic exercises may be an attractive alternative to land-based exercises for individuals with musculoskeletal conditions such as low muscle tone and excess adiposity as found in adults with DS. As a result, the purpose of the current study was to study the effect of an aquatic training intervention on the functional fitness for adults with DS.

METHODS

Participants were recruited from two intellectually disabled care centres in the Western Cape of South Africa. Twenty-three adults with DS (13 men and 10 women) (31.4 ± 7.4 years) were allocated to an aquatic training group or a control group. The exercise group performed 35 min of aquatic training, three times a week for 6 weeks, with an increase duration of 45 min after 3 weeks. Outcome measures assessed were aerobic capacity, muscular strength, functional ability and balance.

RESULTS

The aerobic capacity and functional ability of the participants in the aquatic group improved significantly than in the control group with strong to medium effect sizes. Two out of the three strength parameters also improved significantly than in the control group.

CONCLUSIONS

The functional fitness of adults with DS improved with an aquatic intervention but was insufficient to improve balance and upper body strength. The improvement of various parameters associated with functional fitness is important in this population who age prematurely, suffer from the early onset of age-related conditions, are vulnerable to falls and susceptible to chronic conditions.

Musculoskeletal anomalies in children with Down syndrome: an observational study

BACKGROUND

Musculoskeletal complications of Down syndrome (DS) are common but infrequently reported. The combination of ligamentous laxity and low muscle tone contributes to increased risk of a number of musculoskeletal disorders and a delay in acquisition of motor milestones. The primary aim of this study was to describe musculoskeletal anomalies reported in a national cohort of children with DS.

METHODS

This was an observational study. Children with DS, aged 0-21 years, were invited to attend a musculoskeletal assessment clinic conducted by a paediatric physician. Relevant musculoskeletal history and clinical findings were documented.

RESULTS

Over an 18-month period, 503 children with DS were examined (56% male). The median age was 8.1 years (0.6-19.2). Pes planus was almost universal, occurring in 91% of the cohort. A range of other musculoskeletal anomalies were observed, with inflammatory arthritis (7%) and scoliosis (4.8%) occurring most frequently after pes planus. Delay in ambulation was common; the median age to walk was 28 months (12-84).

CONCLUSION

Children with DS are at increased risk of a number of potentially debilitating musculoskeletal problems. These conditions can present in variable manners or be completely asymptomatic. Pes planus is common; therefore, early consideration of orthotics and lifelong appropriate supportive footwear should be considered. Delayed ambulation is frequently noted. A significant proportion of children with DS have arthritis; however, despite a high prevalence, it is often missed, leading to delayed diagnosis. An annual musculoskeletal assessment for all children with DS could potentially enable early detection of problems, allowing for timely multidisciplinary team intervention and better clinical outcomes.

Physical fitness of children and adolescents with moderate to severe intellectual disabilities

Background: Low levels of physical fitness are associated with low physical and mental health. The aims of this study were to assess the health-related physical fitness of children with intellectual disability (ID), and study the association of physical activity and motor development with physical fitness.Methods: One hundred and twenty-eight children with moderate to severe ID (83 boys; age 2-18 years) visiting specialised day programme centres engaged in field-based physical fitness tests (body composition, muscular strength, muscular endurance, and cardiorespiratory fitness). Scores were compared to reference values, and with linear regression analysis the association between the fitness outcomes and physical activity and motor development was studied.Results: High rates of overweight (23-25%) and obesity (10-15%) were found. A majority of the participants (71-91%) scored below reference values for muscular strength, endurance, and cardiorespiratory fitness tests. Physical activity and motor development were positively associated with scores on several fitness test (β = 0.27-0.44; p < 0.05).Conclusions: Children with moderate to severe ID visiting specialised day programme centres have strikingly low physical fitness levels. Policies and interventions to increase the physical fitness for this specific group of children are urgently needed, in which increasing physical activity and motor skills are expected to be effective components.Implications for rehabilitationStrikingly low levels of physical fitness were seen in children and adolescents with moderate to severe intellectual disabilities.This vulnerable group is in need of appropriate interventions to increase their physical fitness levels.Increasing the physical activity is a potential component in these interventions.Improving motor development will most likely lead to improved physical fitness as well.

Motor efficacy of individuals with Down Syndrome as part of their rehabilitation

Introduction: Down syndrome is the most common chromosomal developmental disorder. Due to the abnormalities of psychophysical development occurring in people with Down Syndrome, it is necessary to implement their rehabilitation. This process should enable achieving and then maintaining an optimal level of physical, mental and social functioning. It can be done through a planned motor efficacy improvement programme. Nowadays, the level of motor efficacy is recognized as a positive measure of health, as well as versatile resourcefulness. Study aim: The cognitive aim of the study was to determine the level of motor efficacy in individuals with Down Syndrome and to show the results of this group compared to those with intellectual disabilities but without Down Syndrome. The applicative goal of the research is to show motor fitness as a factor increasing the effectiveness of functioning in everyday life, which is one of the goals of rehabilitation. Material and methods: The study was conducted among 30 individuals with Down Syndrome of moderate intellectual disability. The method of research was direct observation, the tool – the Eurofit Special Motor Fitness Test. Results: Based on the results, it was noted that the developmental state in the area of motor skills of people with Down Syndrome is lower than in their peers with intellectual disability without Down syndrome. Only balance shows a significantly higher level in the study group compared to the control group. Conclusions: The results obtained in the study may be a starting point when planning improvement programmes being part of the rehabilitation process. Improving the level of motor fitness, which is the expected effect of rehabilitation, will also contribute to improving the health and social functioning of people with Down Syndrome.

Factors affecting participation in physical activities in Saudi children with Down syndrome: mothers' perspectives

PURPOSE

Physical activity provides a wide range of benefits. Several studies conducted in various countries have examined factors influencing participation in physical activities in children with Down syndrome. This study aimed to explore factors affecting participation in physical activities in Saudi children with DS, from their mothers' perspectives.

MATERIALS AND METHODS

In-depth interviews were conducted with 36 mothers of children with Down syndrome to explore facilitators of and barriers to their children's participation in physical activities. All audio recordings were transcribed, validated, reviewed by the authors independently, and organized into themes.

RESULTS

Transcript analysis resulted in four facilitators (mother's support and siblings' involvement, involvement of peers, type of physical activity experience, and child's physical ability, behavioral, and psychological status), and six barriers (conditions associated with Down syndrome, family responsibility, social barriers, environmental constraints, electronic devices, and mother's personal psychological barriers).

CONCLUSIONS

The results regarding perceived barriers indicated a need to develop and implement programs involving family consultation. Environmental modifications should be made to accommodate the needs of children with Down syndrome. A well-organized partnership should be established and activated between private investors and the Ministries of Education, Social Affairs, and Health, to support the promotion of physical activity. Implications for rehabilitation The efficacy of home- and Internet-based programs for Saudi children with Down syndrome (DS) should be evaluated. Cultural and climactic conditions in Saudi Arabia suggest the need for environmental modifications to help children with DS engage in physical activity. Well-organized partnerships between private investors and the Ministries of Education, Social Affairs, and Health may be required to achieve higher participation of children with DS. Planning and designing of strategies, policies, facilities, and programs are required to increase engagement in physical activity and maximize the benefits of participation of children with DS.

Physical activity and bone mineral density at the femoral neck subregions in adolescents with Down syndrome

BACKGROUND

Low bone mineral density (BMD) has been frequently described in subjects with Down syndrome (DS). Reduced physical activity (PA) levels may contribute to low BMD in this population. The objective of the study was to investigate whether PA levels were related to the femoral neck bone mass distribution in a sample of 14 males and 12 females with DS aged 12-18 years.

METHODS

BMD was evaluated by dual energy X-ray absorptiometry (DXA) at the integral, superolateral and inferomedial femoral neck regions and PA levels were assessed by accelerometry. The BMDs between the sexes and PA groups (below and above the 50th percentile of the total PA) were compared using independent t-tests and analyses of covariance (ANCOVAs) controlling for age, height and body weight.

RESULTS

No differences were found between the BMDs of males and females in any femoral neck region (p>0.05). Females with higher PA levels demonstrated increased integral (0.774 g/cm2 vs. 0.678 g/cm2) and superolateral femoral neck BMDs (0.696 g/cm2 vs. 0.595 g/cm2) compared to those with lower PA levels (p<0.05). In males, no differences (p<0.05) were found in the BMDs between the PA groups.

CONCLUSIONS

This investigation shows that females accumulating more total PA presented increased BMDs at the integral and superolateral femoral neck regions (14.1% and 17.0%, respectively) when compared to their less active peers. These data highlight the importance of PA in females with DS to counteract their low bone mass and to improve their bone health.

Wii-based exercise program to improve physical fitness, motor proficiency and functional mobility in adults with Down syndrome

BACKGROUND

People with Down syndrome (DS) usually display reduced physical fitness (aerobic capacity, muscle strength and abnormal body composition), motor proficiency impairments (balance and postural control) and physical functional limitations. Exergames can be an appealing alternative to enhance exercise engagement and compliance, whilst improving physical fitness and motor function. This study aims to analyse the effects of a Wii-based exercise program on physical fitness, functional mobility and motor proficiency of adults with DS.

METHODS

Twenty-seven adults with DS were randomly allocated to an experimental group (Wii; n = 14) or control group (n = 13). Participants in the experimental group completed a 2-month Wii-based exercise program, with three 1-h sessions per week that included training games for aerobic endurance, balance and isometric strength. Participants completed assessments regarding anthropometric measures, physical fitness, functional mobility and motor proficiency.

RESULTS

Mixed ANOVA analysis showed a significant group by time interaction for aerobic endurance, explosive leg power and flexibility. Independent samples t-test for change scores indicated significant between-group differences favouring the experimental group regarding speed of limb movement, trunk strength and functional mobility, as well as a trend towards significance on body weight. Mann-Whitney's U test for change scores demonstrated between-group differences favouring the experimental group for visceral fat as well as running speed and agility. Large within-group effect sizes were observed for explosive leg power (d = 1.691), body weight (d = 1.281), functional mobility (d = 1.218), aerobic endurance (d = 1.020), speed of limb movement (d = 0.867) and flexibility (d = 0.818) in the experimental group.

CONCLUSIONS

Our findings suggest that Wii-based exercise can be an effective tool to improve physical fitness, functional mobility and motor proficiency of adults with DS, including crucial measures such as aerobic capacity and lower limb strength. Exergames using Wii Fit or other equipment can be appealing alternatives for adults with DS to engage in regular physical activity, preventing sedentary behaviour and decreasing the risk to develop cardiovascular diseases.

Impairments in the Visual Processing of Global Biological Motion Cues in Down Syndrome

Down syndrome (DS) is one of the most common chromosomal disorders and is often associated with a number of motor and cognitive impairments. Little research has been dedicated to investigating the perceptual abilities of individuals with DS. The visual processing of biological motion has been shown to be impaired in DS. It has been proposed that these impairments may stem from an inability to process the global patterns of full-body motion produced by a moving actor; however, this has not been explicitly investigated. We tested groups of participants with and without DS on a task requiring the visual discrimination of point-light walkers from spatially scrambled versions of point-light walkers. Participants with DS demonstrated poorer performance and slower reaction times on the task than healthy controls. From these results, we conclude that biological motion processing is impaired in DS and that this deficit is related to an inability to integrate global configural cues. In a second experiment, individuals with DS were able to discriminate the direction in which laterally translating walkers moved, suggesting that the global motion processing deficit observed in Experiment 1 is specific to biological motion recognition and does not generalise to other types of global motion.

Socioeconomic indicators, obesity, and physical fitness in south Brazilian adolescents with Down syndrome

Objectives: The aim was to examine the association of potential socioeconomic indicators with obesity and physical fitness components in south Brazilian adolescents with Down syndrome. Methods: This study comprised a total of 1249 (669 boys) adolescents with Down syndrome aged 10 to 20 with complete baseline data. Socioeconomic indicators were assessed by a proxy-report questionnaire. Body mass index and physical fitness were assessed using a PROES-BR health-related fitness test battery. Results: Socioeconomic status is not associated with body mass index in adolescents with Down syndrome. In addition, two of five physical fitness variables were associated with groups of family income and paternal education level in boys, while one of five physical fitness variables were associated with groups of paternal and maternal education level in girls. Conclusion: Our results suggest that socioeconomic indicators are associated with some components of physical fitness in Brazilian adolescents with Down syndrome. These associations depend on the socioeconomic status and physical fitness components in boys and girls.

Percentage of body fat in adolescents with Down syndrome: Estimation from skinfolds

BACKGROUND

Adolescents with Down syndrome (DS) have a unique morphology and body shape, and this needs to be taken into account when assessing body fat percentage (BF%).

OBJECTIVE

To develop a predictive equation from anthropometric variables (skinfolds) for estimating BF% in adolescents with DS.

METHODS

Twenty-three adolescents with DS (7 girls, 16 boys) participated in the study; seven skinfold measurements were taken (biceps, triceps, subscapular, supraspinale, abdominal, front thigh, and medial calf), circumferences and diameters were measured following ISAK recommendations. Total body volume (and then body density) was measured with air displacement plethysmography (ADP); BF% was then calculated. Correlation between anthropometry data and BF% by ADP, and stepwise regression analyses were applied to develop a specific prediction equation.

RESULTS

All the skinfolds, BMI, hip, waist and thigh circumferences correlated with BF% and were included in the regression analysis; sex and triceps were added into the model (R² = 0.89, p < 0.05). Therefore the proposed equation computed as follows: BF% = (0.97 TR) - (8.869·SEX) + 15.6 where TR is triceps skinfolds (mm) and SEX is equal to 0 for female and 1 for male.

CONCLUSIONS

The proposed prediction equation is recommended for the assessment of BF% in adolescents with DS as it is the only one specifically developed and validated in this unique population. It is a cheap, reliable and accessible method that removes the need for use of expensive equipment.

Effect of continuous aerobic vs. interval training on selected anthropometrical, physiological and functional parameters of adults with Down syndrome

BACKGROUND

A large percentage of adults with Down syndrome (DS) are overweight and have extremely low aerobic capacities compared with the general population and persons with intellectual disability without DS. Previous aerobic training intervention studies showed limited potential to significantly ameliorate anthropometrical and cardiovascular variables. The primary purpose of this study was to determine the effect of continuous aerobic training (CAT) vs. interval training (IT) on selected anthropometrical, health, physical and functional parameters of adults with DS.

METHODS

Forty-two adults with DS (25 men and 17 women) and a mean age of 33.8 (±8.6) years were randomly allocated to one of three groups (IT, CAT and control). Training was performed for 12 weeks. The IT group performed 10-30 s all out sprints with 90 s (1:3 work-rest ratio) of low cadence, low intensity cycling or walking. The CAT group performed continuous cycling and walking at an intensity of 70-80% of VO₂ peak. Heart rate monitors were used for monitoring training intensities. After 6 weeks of training, the intensity of the CAT was increased to 85% of VO₂ peak, whilst the intensity of the IT group remained 'all out'. An increase of 5 min in duration was implemented after 6 weeks for both training groups. To evaluate pre-post differences between groups, a repeated analysis of covariance with post hoc Bonferroni test was performed RESULTS: After 12 weeks of training, body weight and body mass index decreased significantly more in the IT group compared with control and CAT (P < 0.05). Participants in the IT group decreased their body weight from 71.4 ± 8 to 69.4 ± 8 kg and their body mass index from 29.3 ± 4 to 28.5 ± 4 kg/m² . Significant ameliorations for functional parameters and leg strength were shown for CAT compared with control (P < 0.05). Participants in the CAT group improved their performance in the 6 minute walk distance (499 ± 78 to 563 ± 75 m), 8-ft up-and-go (5.9 ± 1.2 to 4.8 ± 0.9) and leg strength (13.1 ± 2 to 15.2 ± 2). VO₂ peak and time to exhaustion significantly improved in both the IT and CAT group compared with control (P < 0.01). Moreover, a significant improvement for relative VO₂ peak was also determined for IT compared with CAT (P < 0.05). Participants in the IT group increased their VO₂ peak from 32 ± 8 to 37 ± 8 mL/min/kg. Submaximal heart rate and VO₂ values improved significantly within both exercise groups (P < 0.05).

CONCLUSION

Interval training and CAT can both be pursued by adults with DS to positively impact on various parameters of anthropometry, fitness and functional ability, with IT more appropriate for improving body weight and aerobic capacity.

Effect of whole-body vibration training on bone mass in adolescents with and without Down syndrome: a randomized controlled trial

Whole-body vibration training (WBV) attracts great interest as osteoporosis prevention strategy. Twenty-six adolescents with and without Down syndrome (DS) (13 DS; 12-18 years) performed 20 weeks of WBV. The results indicate that WBV seems to provoke a lesser response in adolescents with DS than in those without DS.

INTRODUCTION

This study aims to observe the differences between adolescents with and without DS in the effects of 20 weeks of WBV training, on bone mineral content (BMC) and density (BMD).

METHODS

Twenty-six adolescents (13 DS; 12-18 years) were measured with dual-energy X-ray absorptiometry before and after the intervention (3/week, 10 repetitions (30-60 s) and 1-min rest, frequency 25-30 Hz and peak-to-peak displacement of 2 mm (peak acceleration 2.5-3.6 g)). Both, an intention-to-treat (ITT) analysis designed to assess the effects on bone mass and a per-protocol analysis, designed to compare poor and high compliers, were performed.

RESULTS

The ITT analysis revealed significant increases in all BMC and BMD parameters (dz = 0.66 to 1.64; all p < 0.05) in the non-DS group, whilst DS group improved whole-body, subtotal (whole-body less head), upper limbs (ULIMBS), pelvis, lower limbs (LLIMBS) and spine BMC (dz = 0.75 to 1.76; all p < 0.05) and subtotal, pelvis, LLIMBS and spine BMD (dz = 0.73 to 1.28; all p < 0.05). Significantly greater increases were evident in the absolute and percent changes of the non-DS group over DS group (d = 0.88 to 3.85; all p < 0.05). ULIMBS BMD showed a tendency towards an interaction (f = 0.41 and p = 0.086) with higher increase for non-DS group. When a per-protocol analysis was considered, high-complier adolescents had 8.1 versus 5.3 % of gains in the spine BMC over poor-complier adolescents (d = 0.93; p < 0.05).

CONCLUSIONS

Twenty weeks of WBV training may improve BMC and BMD in clinically relevant skeletal sites in both groups. Nevertheless, this type of training seems to provoke a lesser response in adolescents with DS than in those without DS.

Test-retest reliability and minimal detectable change scores of twelve functional fitness tests in adults with Down syndrome

AIM

The purpose of the study was to explore the test-retest reliability and minimal detectable change of selected functional fitness test items in adults with Down syndrome.

METHODS

Forty-three adults with Down syndrome (24 men and 19 women) aged 18-50 years completed a battery of tests twice in a two-week period. The battery of tests consisted of two balance items, two flexibility items, five muscular strength and endurance items, two aerobic items, and one functional task. All items were considered valid and reliable tests in a general elderly or intellectually disabled population. The test-retest relative reliability for all repeated tests was assessed with intraclass correlation coefficient performing one-way analysis of variance. The test-retest absolute variability was measured by using the standard error of measurement (SEM) to calculate the minimal detectable change at the 90% confidence interval (MDC90). Reliability data was visualised with a Bland-Altman plot.

RESULTS

All tests showed excellent intraclass correlation coefficients (ICC's>0.9). All SEM values demonstrated acceptable measurement precision (SEM<SD/2). Values for MDC90 are provided for all 12 tests. The analyses indicated that there was no major systematic bias in the plots. The scatter around the Bland-Altman was distributed randomly.

CONCLUSION

All twelve functional fitness tests demonstrated adequate feasibility and relative and absolute test-retest reliability in adults with Down syndrome in South Africa. Information of this nature will help to monitor performance alterations over time and success of training interventions.

Occupational therapy based on Canadian Model of Occupational Performance and Engagement in rehabilitation process in patient with rheumatoid arthritis

Introduction: The article introduces the fundamental principles of the Canadian Model of Occupational Performance and Engagement (CMOP-E) and the Canadian Practice Process Framework (CPPF).

Case study: The model specifies and describes the main areas of interest of occupational therapists ‒ the person, the occupation and environment, and mutual relations and interdependencies between these components. It takes into consideration not only the aspect the occupation being performed by the patient, but also the significance of the patient’s involvement in the activity performed. The Canadian model is based on the model of client-centred practice.

Summary: Apart from the elaboration on the theoretical principles of the CPPF-based therapeutic process, this paper also presents an example of the practical application of this model involving work with a rheumatoid patient.

Effect of whole body vibration training on bone mineral density and bone quality in adolescents with Down syndrome: a randomized controlled trial

Adolescents with Down syndrome (DS) have poorer bone health than their peers without DS. Twenty-five adolescents with DS were randomly assigned to whole-body vibration training (WBV) or control groups. The results indicate that a 20-week WBV might be useful to improve subtotal bone mineral content and density in adolescents with DS.

INTRODUCTION

This study aims to determine the effects of 20 weeks of whole body vibration training (WBV) on bone mineral content (BMC), density (BMD), and structure variables in adolescents with Down syndrome (DS).

METHODS

This randomized controlled trial of 25 adolescents (12-18 years) with DS (8 females) generated 2 non-equal groups, WBV group (n = 11) and CON group (n = 14). Using an efficacy analysis, the primary outcomes were BMC and BMD by dual-energy X-ray absorptiometry and the secondary were bone structure variables by peripheral quantitative computed tomography. A synchronous vibration platform (PowerPlate®) was used (3/week, 10 repetitions (30-60 s) 1-min rest, frequency of 25-30 Hz, and peak-to-peak displacement of 2 mm (peak acceleration 2.5-3.6 g)).

RESULTS

WBV group improved whole body BMC 2.8%, 95% CI [3.5, 2.1], subtotal area, BMC, and BMD by 2.8, 4.8, and 2%, respectively, 95% confidence intervals (CIs) [3.4, 2.1], [6.5, 3.1], and [2.8, 1.1], respectively (all, p < 0.05), showing group by time interactions in BMC and BMD (both p < 0.05). Lumbar spine BMC and BMD also increased in the WBV group by 6.6 and 3.3% both p < 0.05, 95 % CIs [8.6, 4.7], and [4.9, 1.7], respectively. Regarding bone structure, WBV group showed improvements in tibial BMC at 4 % (2.9 %, 95 % CI [3.0, 2.8]) and in volumetric BMD (vBMD), cortical vBMD, and cortical thickness at 66% of the radius (by 7.0, 2.4, and 10.9%; 95% CIs [7.4, 6.7], [2.6, 2.3], and [12.4, 9.3], respectively) (all, p < 0.05).

CONCLUSIONS

A 20-week WBV, with this protocol, might be useful to improve subtotal BMC and BMD in adolescents with DS.

The role of fatness on physical fitness in adolescents with and without Down syndrome: The UP&DOWN study

BACKGROUND/OBJECTIVES

Adolescents with Down syndrome (DS) exhibit higher levels of fatness and low levels of physical fitness compared with those without DS. In adolescents without DS, fatness is tightly associated with physical fitness, but this association is unclear in adolescents with DS. The aim of this study was to examine the association between several markers of fatness and physical fitness in a relative large sample of adolescents with and without DS.

SUBJECTS/METHODS

A total of 111 adolescents with DS (41 females) aged 11-20 years participated in this cross-sectional study. We also included a sex-matched control group (ratio 1:2) of 222 adolescents without DS aged 12-18 years, participating in the UP&DOWN Study. The Assessing Level of Physical Activity (ALPHA) health-related fitness test battery for adolescents was used to assess fatness and physical fitness.

RESULTS

Our results show that fatness is not associated with low levels of physical fitness in adolescents with DS (that is, 3 of the 16 analyses identified differences in physical fitness variables by groups of fatness). In contrast, fatness, as expected, is associated with levels of physical fitness in adolescents without DS (that is, 13 of the 16 analyses identified differences in physical fitness variables by groups of fatness).

CONCLUSIONS

The present finding contributes to new knowledge by suggesting that the role of fatness on physical fitness is different in adolescents with and without DS, and consequently, the poor levels of physical fitness in adolescents with DS may be due to the syndrome rather than the high prevalence of obesity from this population.

Effects of two programs of exercise on body composition of adolescents with Down syndrome

Objective:

To investigate the effects of a 12 week aerobic and resistance exercise on body composition of adolescents with Down syndrome.

Methods:

A quasi-experimental study with 41 adolescents with Down syndrome, aged 15.5±2.7 years, divided into three groups: Aerobic Training Group (ATG; n=16), Resisted Training Group (RTG; n=15) and Control Group (CG; n=10). There were two types of training: aerobic, with intensity of 50-70% of the heart rate reserve 3 times/week, and resisted, with intensity of 12 maximum repetitions 2 times week. Both trainings were applied during a 12-week period. The percentage of fat evaluation was performed using plethysmography with Bod Pod^(r) equipment. Waist circumference (WC), body weight and height were also measured. Paired t-test was used to compare variables before and after the exercise program.

Results:

The percentage of body fat did not change significantly for both groups that participated in the training intervention. However, CG showed a significant increase in this variable (31.3±7.2 versus 34.0±7.9). On the other hand, body mass index (BMI) and WC were significantly reduced for ATG (BMI: 27.0±4.4 and 26.5±4.2; WC: 87.3±11.1 and 86.2±9.7), while RTG and GC showed no differences in these variables.

Conclusions:

The aerobic and resisted training programs maintained body fat levels. ATG significantly reduced BMI and WC measures. Individuals who did not attend the training intervention increased their percentage of fat.

The scope of pediatric physical therapy practice in health promotion and fitness for youth with disabilities

PURPOSE

The purpose of this report is to discuss the scope of pediatric physical therapy practice in health promotion and fitness for youth with disabilities.

SUMMARY OF KEY POINTS

Evidence is provided that supports integration of health promotion and fitness strategies in physical therapy clinical management. Physical therapists' roles in community-based adapted sports and fitness interventions and reimbursement considerations are discussed.

CONCLUSIONS

Physical therapists are in a unique position to provide expertise in the design and implementation of health promotion and fitness programs for youth with disabilities. These programs are important to promote active, healthy lifestyles and reduce comorbidities associated with sedentary behaviors and unhealthy weight, which are often seen in youth with disabilities.

RECOMMENDATIONS FOR CLINICAL PRACTICE

Pediatric physical therapists should incorporate health promotion and fitness strategies into practice.