Validity of the 16-metre PACER and six-minute walk test in adults with Down syndrome

Factors Associated With Depression in Caregivers of Adults With Down Syndrome

BACKGROUND

Family caregivers of those with developmental disabilities have higher rates of depression and anxiety compared with caregivers of those without development disability. Few studies have examined factors that contribute to caregiver depression, including the appraisal of caregiving responsibilities and the physical fitness and daily function of the care recipient. The purpose of this study was to identify intrapersonal (caregiver) and interpersonal (care recipient) factors associated with depressive symptoms in caregivers of adults with Down syndrome (DS).

METHODS

Twenty-four adults with DS participating in a 12-month physical activity trial completed physical fitness and function tests (VO2peak, hand grip strength, timed up and go, five times sit to stand) and activities of daily living (ADL) surveys at their baseline visit. Caregivers (n = 24) of the adults with DS completed surveys on caregiving distress, quality of life (QoL) and depressive symptoms. We evaluated the associations of these assessments on caregiver depressive symptoms using Mann-Whitney U tests and Spearman correlations.

RESULTS

Adults with DS were 23 ± 7.5 years, 58% female; caregivers were 54 ± 10 years, 100% female, 96% family members. Caregiver depressive symptoms were significantly associated with caregiving distress (p = 0.024) and caregiving QoL (r = -0.58, p = 0.003). Hand grip strength of care recipients was inversely correlated with caregiver depressive symptoms (r = -0.45, p = 0.03), but other assessments of physical function and ADL were not associated with caregiver depressive symptoms.

CONCLUSIONS

Caregiver depressive symptoms were related to modifiable factors related to the caregiver and care recipient. Intervening to improve caregiving appraisal and functional strength of the care recipient may positively impact caregiver mental health.

Concurrent Validity of Abbreviated Walk Tests Among Adults With Mild to Moderate Intellectual Disability

BACKGROUND

Walk tests are common gait speed and endurance assessments. Shorter test versions could benefit adults with intellectual disability. Thus, the concurrent validity of shorter tests was studied.

METHODS

Thirty-five adults with mild to moderate intellectual disability, aged 21-64 years, were assessed with the 4-m walk test, 10-m walk test for gait speed, 2-min walk test, and 6-min walk test for endurance. Correlation and Bland-Altman plots analyses were used to establish concurrent validity between shorter and standard tests.

RESULTS

Strong positive relationships were found for gait speed tests, r = 0.94, p < 0.001, and endurance tests, r = 0.83, p < 0.001, and differences between shorter and standard tests were within limits of agreement.

CONCLUSIONS

The concurrent validity of shorter walk tests was established in this study. This would mean that adults with intellectual disability with lower levels of fitness could be assessed.

TRIAL REGISTRATION

Australian New Zealand Clinical Trial Registry: ACTRN12624000203550.

Measurement protocols and determinants of peak oxygen consumption in adults with Down syndrome: a systematic review

This systematic review aimed to provide an overview of test protocols used to measure peak oxygen uptake (VO2peak) in adults with Down syndrome (DS) and to determine how generalisable the outcomes are for the entire population of adults with DS by describing the sample characteristics of these studies and their impact on VO2peak. A literature search (PROSPERO CRD42022309560) was performed (18 July 2023) using the following databases: PubMed, CINAHL, APA PsycINFO, Web of Science, Embase and SPORTDiscus. For articles to be included, they had to be peer-reviewed pubications, reporting VO2peak or VO2max for individuals with DS separately, with a sample of n ≥ 5 and a mean age ≥18 years. Systematic reviews and meta-analyses were excluded but their reference lists were searched for additional papers to include. Studies were evaluated for risk of bias following the guidelines of Kmet et al. The results were summarised with frequency statistics. Forty-three studies were included in this systematic review. Sample sizes of included adults with DS ranged from n = 4-226, with a total of n = 1498 adults with DS being included. Most studies (29/43) used the same standardised maximal exercise treadmill protocol to measure VO2peak in adults with DS, and 33 out of 43 studies used at least one objective criterion to determine a valid maximal effort. Participants were predominantly male, under 40 years old, and overweight or obese. Additionally, the diversity of study samples was lacking or not reported. The most widely used, standardised, maximal exercise test treadmill protocol is recommended for future use in research and practice, including objective criteria to determine valid maximal effort. The current study samples are not representative of the population of adults with DS in terms of sex, age and diverse backgrounds and therefore likely overestimate VO2peak of this population.

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.

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.

Reference equations for the six-minute walking distance in obese Chinese subjects more than 40 years old

BACKGROUND

Studies have shown that the reference equations for the six-minute walking distance (6MWD), which were mainly derived from healthy, normal-weight people, are not suitable for individuals with obesity. The main purpose of this study was to establish reference equations for the 6MWD in obese Chinese subjects.

METHODS

In our study, a total of 214 individuals with obesity performed the six-minute walking tests (6MWTs) according to the American thoracic society (ATS) guidelines, and the longer 6MWD was used for further analysis. The reference equations for the 6MWD were developed using stepwise multiple regression analysis. The newly established equations for the 6MWD were compared to the existing prediction equations.

RESULTS

The mean 6MWD for the cohort was 523 ± 56 m. We found that the reliability of two 6MWTs was good. Age and BMI were identified as independent factors, and explained 31% and 27% of the variance in the 6MWD for the male and female participants, respectively. Thus, the reference equations reported in the previous studies did not accurately predict the 6MWD in our subjects.

CONCLUSION

Our study was the first to describe the 6MWD in obese Chinese subjects and to propose new predictive equations. These established equations can improve the assessment of the health of obese Chinese patients whose exercise capacity is affected by the disease.

LEVEL OF EVIDENCE

III, Cohort study.

A systematic review and meta-analysis of the effects of aerobic exercise interventions on cardiorespiratory fitness in adults with intellectual disability

BACKGROUND

Adults with an intellectual disability (ID) have low cardiorespiratory fitness (CRF). Low CRF has been associated with a high risk of cardiovascular disease and all-cause mortality. Participation in regular exercise can help adults with ID increase their CRF.

OBJECTIVE

To perform a systematic review and meta-analysis of published, peer-reviewed clinical trials that evaluated the effects of aerobic exercise (AE) interventions on CRF in adults with ID, ages 18-65 years.

METHODS

English-language articles were searched up to June 2021 from 11 electronic databases. Data were extracted using an author-developed form. Two independent authors assessed the risk of bias using the Tool for the Assessment of Study Quality and reporting in Exercise (TESTEX). Meta-analysis was performed using the RevMan 5.3.

RESULTS

Of the 1870 article titles and abstracts screened, 16 articles were included. The average TESTEX score (out of 15) was 8.1 (SD = 3.5, range 2-14). The pooled effect was statistically significant (SMD = 0.41, 95% CI: 0.19 to 0.63, z = 3.59; p = .000) with moderate heterogeneity (I² = 35%, p = .000). Both types of intervention produced statistically significant CRF gains, with interventions that combined AE with resistance, balance, and/or flexibility exercises being slightly more effective (SMD = 0.40, 95% CI: 0.11 to 0.70, p = .007) than non-combined interventions (SMD = 0.42, 95% CI: 0.05 to 0.79, p = .02). Heterogeneity was moderate but non-significant for both types of intervention.

CONCLUSIONS

The review supports the use of AE interventions in promoting CRF in adults with ID. The interpretation is limited by the quality of evidence and by poorly described and/or executed familiarization and measurement protocols.

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.

Testes funcionais validados em indivíduos hospitalizados e não hospitalizados: revisão sistemática

Objetivo: Realizar uma revisão sistemática sobre os testes funcionais validados em diferentes perfis de indivíduos hospitalizados e não hospitalizados e avaliar as evidências psicométricas para confiabilidade e validade. Métodos: Trata-se de uma revisão sistemática. Foram utilizadas as bases de dados EMBASE, MEDLINE, Lilacs e SciELO com as palavras-chave Functional Tests (Walk Test, Gait Speed Test, Chair Stand Test, Timed Up And Go, Step Test),Validation Studies as Topic e sinônimos. Foram incluídos estudos de validação de testes funcionais em indivíduos hospitalizados ou não hospitalizados que utilizaram os critérios de validade e/ou confiabilidade e relacionaram os testes a diferentes variáveis. Esses artigos poderiam ser observacionais longitudinais ou de corte transversal ou estudos de validação que utilizaram dados de ensaios clínicos. Foram excluídos os artigos que não apresentaram características importantes da amostra e a descrição do teste. Resultados: A pesquisa resultou em 36.150 artigos, e 89 foram incluídos. Os estudos foram organizados em tabelas com informações como autor, ano; critérios de validação; amostra; teste; variáveis associadas; resultados. A qualidade dos artigos foi avaliada por meio da Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Conclusão: Os testes funcionais são válidos e confiáveis para a avaliação de indivíduos hospitalizados e não hospitalizados, estando associados à força muscular, capacidade de caminhar, controle postural, atividades de vida diária, risco de quedas, hospitalização e mortalidade.

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.

Feasibility and reliability of the Assessing Levels of Physical Activity health-related fitness test battery in adults with intellectual disabilities

BACKGROUND

People with intellectual disabilities (IDs) seem to have a lower physical fitness (PF) than their peers without disabilities, which coincides with reduced autonomy, life expectancy and quality of life. To assess PF in these individuals, it is necessary to use appropriate tools that permit the assessment of their physical capacities taking into account their specific characteristics. The aim of this work is to study the feasibility and reliability of the Assessing Levels of Physical Activity (ALPHA)-Fit test battery for adults in a group of men and women with mild to moderate ID.

METHODS

Forty-one adults with ID of both sexes, ranging in age from 20 to 60 years old, participated in the study. To identify the feasibility and reliability of the ALPHA-Fit test battery for adults, two complete assessments were done for each one of the tests included in the battery. The assessments were performed for a period of no more than 2 weeks (test-retest). An intraclass correlation coefficient was used to determinate test-retest reliability, and a mixed analysis of variance factorial was used for each of the dependent variables. Bland-Altman plots were also used to assess consistency between the two measurements. Feasibility was calculated as the percentage of people who were able to perform the tests correctly (not feasible <50%, fairly feasible 50%-75% and feasible >75%). In order to determine other psychometric properties, minimal detectable change and standard error of measurement (SEM) were also calculated.

RESULTS

Of the 10 tests in the ALPHA-Fit test battery, eight were shown to be feasible. High reliability was obtained (>0.90) for the variables related to body composition. In the hand-grip test, reliability was high in the men's group but low in the women's group. Good reliability results were also found (0.80-0.89) in the dynamic sit-up test for women, but not for men. Fair reliability (0.70-0.79) was found in jump-and-reach and neck-shoulder mobility tests. The variables in the 2-km walk and agility tests indicated poor reliability. All tests showed SEM values related to high variability. However, Bland-Altman plots showed results related to lack of consistency.

CONCLUSIONS

The feasibility and reliability calculations, as well as the SEM values, confirm that not all the tests of the ALPHA-Fit Test Battery for Adults are suitable for the assessment of PF in adults with ID, probably because of the complexity of the motor fitness tests. The authors emphasise the necessity of making adaptations to the protocols used or of using other tests more appropriate to the characteristics of people with mild to moderate ID.

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.

Reliability and Validity of the 6-Minute Walk Test in Hypophosphatasia

This investigation evaluated the reliability and validity of the 6‐Minute Walk Test (6MWT) in patients with pediatric hypophosphatasia (HPP). Children (aged 6 to 12 years; n = 11), adolescents (13 to 17 years; n = 4), and adults (18 to 65 years; n = 9) completed the 6MWT at screening and baseline in two clinical studies of asfotase alfa. Test‐retest reliability of the 6MWT, evaluated with Pearson's correlation coefficients (r) for screening versus baseline, was high for children (r = 0.95; p < 0.0001), adolescents (r = 0.81; p = 0.125), and adults (r = 0.94; p = 0.0001). The most conservative minimal clinically important differences, estimated using distribution‐based methods, were 31 m (children and adults) and 43 m (adolescents). In children, the 6MWT correlated significantly with scores on measures of skeletal disease, which included the Radiographic Global Impression of Change scale (r = 0.50; p < 0.0001) and the Rickets Severity Scale (r = −0.78; p < 0.0001), such that distance walked increased as the severity of skeletal disease decreased. Significant (p < 0.0001) correlations with the 6MWT distance walked were also observed for children with scores on parent‐reported measures of disability (r = −0.67), ability to function in activities of daily living (r = 0.71 to 0.77), and parent‐reported measures of pain (r = −0.39). In adolescents and adults, 6MWT distance walked correlated significantly (p < 0.05) with measures of lower extremity function (r = 0.83 and 0.60, respectively), total pain severity (r = −0.41 and −0.36, respectively), and total pain interference (r = −0.41 and −0.49, respectively). Collectively, these data indicate that the 6MWT is a reliable, valid measure of physical functioning in patients with pediatric HPP. © 2018 The Authors. JBMR Plus Published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.

Reference Equations for the Six-Minute Walk Distance in the Healthy Chinese Han Population, Aged 18-30 Years

Background

The six-minute walk test (6MWT) is a safe, simple, inexpensive tool for evaluating the functional exercise capacity. However, there is a lack of standard reference equations for the six-minute walk distance (6MWD) in the healthy Chinese Han population with an age of 18–30 years. The aims of the present study were as follows: 1) to measure the anthropometric data and the walking distance in a sample of healthy Chinese Han population, aged 18–30 years; 2) to construct reference equations for the 6MWD; 3) to compare the measured 6MWD of our cohort with previously published equations.

Methods

The anthropometric data, demographic, lung function and the walking distance of Chinese Han population, aged 18–30 years, were prospectively measured using a standardized protocol. Informed consent was obtained from each participant and the approval was obtained from the ethics committee of Wenzhou People’s Hospital. The 6MWT was performed twice and the longer 6MWD was used for further analysis.

Results

A total of 355 subjects (176 female and 179 male) completed the 6MWT, and the average walking distance was 627.3 ± 52.88 m. The walking distance was achieved by females compared with males (607.4 ± 51.00 m vs. 646.9 ± 47.15 m; p < 0.0001) and active subjects compared with non-active subjects (646.1 ± 48.27 m vs. 611.6 ± 51.52 m; p < 0.0001). Univariate analysis showed age, height, body mass index, resting blood pressure, heart rate and blood pressure after the walk test and difference in heart rate before and after the walk test were significantly correlated with the 6MWD. Stepwise multiple regression analysis showed that height and difference in heart rate before and after the walk test were independent predictors associated with the 6MWD. The reference equations from Caucasian, Canadian and Chilean populations tend to overestimate the walking distance in our subjects, while Brazilian and Arabian equations tend to underestimate the walking distance. There was no significant difference in the walking distance between Korean equations and the current study.

Conclusion

In summary, height and difference in heart rate before and after the walk test were the most significant predictors of the 6MWD, and the regression equations could explain approximately 38% and 31% of the distance variance in the female and male groups, respectively.