THE BENEFITS OF PHYSICAL ACTIVITY FOR INDIVIDUALS WHO HAVE DOWN SYNDROME

written by Acsah Abraham, Undergraduate Student, University of Florida

According to the Centers for Disease Control and Prevention, approximately 13 out of every 10,000 children born in the United States have Down syndrome (1). This makes Down syndrome the most common genetic condition in society today. It is unknown as to why it occurs but “nondisjunction” is the term used in reference to the incorrect division of cells which causes Down syndrome. Instead of having the typical two copies of the 21st chromosome, people who have Down syndrome have three copies of this genetic material.

There are three types of this condition. The most common type is Trisomy 21. It involves the extra chromosome replicating all of the body’s other cells. Translocation is another type of Down syndrome in which chromosome 21 detaches during mitosis, only to attach to another chromosome. The additional chromosome manifests in some attributes of Down syndrome, though only 46 chromosomes are present. Mosaicism, another type, takes place when nondisjunction occurs in just one cell division, resulting in cells with 47 chromosomes (2).

People who have Down syndrome experience physical and mental disabilities that greatly vary in terms of severity. A flat face, large tongue, small hands and feet, and reduced muscle tone are among the widespread physical manifestations of Down syndrome. Other physical problems include skeletal, thyroid, stomach issues as well as Celiac Disease. The only identified risk of having a child with Down syndrome is the increased age of the child's mother. Younger women have children with Down syndrome, but this is simply due to the fact that younger women are more likely to have children than older women. However, Down syndrome is more likely to occur when a child is born to a woman over the age of 35. Though there is no knowable way to prevent Down syndrome, mothers can decrease the risk by having a healthy pregnancy with healthy eating habits and avoiding smoking and alcohol (1).

Down syndrome used to be a much more daunting condition to have about 100 years ago. Around this time, the life expectancy of an individual who was diagnosed with it was just nine years old. Improved technology and breakthroughs in medicine have greatly impacted society in a positive way. Additionally, special learning programs, speech therapy, physical therapy, and occupational therapy have helped people with Down syndrome improve the physical and mental disabilities they may have. It is currently estimated that up to 80% of people who have Down syndrome may live to be sixty years old or even older (2).

Exercise and fitness programs of some sort are important in the weekly regimens for people without disabilities but are especially important for people with disabilities. In particular, people with intellectual disabilities are more likely to be overweight and lead inactive lifestyles. They are also more at risk of acquiring diseases such as Alzheimer's, Leukemia, and Heart Disease. Regarding children who have Down syndrome, the primary aim of physical therapy is not to hasten gross motor development, which is contrary to popular belief. The true objective of physical therapy for children is to keep the typically expected movement patterns of children with Down syndrome to a minimum. Earlier intervention usually results in better eventual outcomes for people with disabilities to keep these expected issues at a minimum or even at bay.

Examples of this are physical therapy focusing on gait and trunk position for children with Down syndrome. Observing how a child performs in physical therapy over time is a good indication of the child's learning patterns. This is significant, as there is overwhelming evidence supporting the major difference in learning patterns between children who have Down syndrome and children who do not.

Physical Therapist Patricia C. Winders listed several "tips" she came to observe, after working with children for 21 years. She noted the importance of the set-up for physical therapy, because children with Down syndrome typically have difficulty generalizing and understanding large amounts of information. She also detected that these children typically learn in a steady four step pattern. This pattern involves introduction, familiarity, collaboration, and independence. As the adult, it is important to intentionally plan how physical therapy sessions ought to run with the child’s best interest in mind. This being said, it is important to follow the child's lead and to avoid interference to change skills that are already mastered (3).

It is unfortunate, but true, that minimal experimentation has been done to show the effects of physical activity for people with intellectual disabilities. However, more testing of this is being done now than ever before. What has been done supports the expectation that exercise enhances fitness and endurance, but studies on other aspects of health have yet to be implemented.

A study was performed specifically to analyze the attitude and psychosocial results of fitness programs and health education for adults who have Down syndrome. The experimenters anticipated that involvement in an exercise program would increase the overall quality of life for the participants. 53 adults above the age of 30 who had Down syndrome were participants throughout the entire study. The control group was composed of 21 people who obtained no special treatment during the study. The experimental group was composed of 32 people who underwent a 12 week program.

The program required exercise and health education, three times a week for two hours each session. The exercise sessions focused on cardio training and building muscle strength. The health education courses taught the participants about exercise and nutrition for adults who have developmental disabilities. It was structured to teach the participants the importance of these things for their health, and to empower their self-efficacy to incorporate these matters into their daily lifestyle. Many elements were observed and measured throughout the experimentation. This included demographics, health status, cognitive and emotional barriers to physical activity and expectations from participation, self efficacy, community integration, depression, and satisfaction with life.

After experimentation, this data was analyzed. Among the participants, 57% participated in some sort of exercise, 59% in the experimental group as opposed to 52% in the control group. 53% of the exercise, the majority that was done, was walking. Other exercises included biking, dancing, and jumping. Both groups had similar perspectives on exercise. Many of the participants thought they did not have enough energy for exercise and considered it boring and difficult. However, 89% of the participants said that they knew exercise would make them look better and 83% expected that they would be happier as a result of being physically active.

There was a major difference in the cognitive and emotional barriers as well as expectations from participation between the two groups. The control group identified more barriers and had little expectation resulting from participating in this study. The experimental group identified fewer barriers and had elevated expectations from participating in the study. Regarding self efficacy in performance, the control group felt more confidence to “stretch muscles.” The experimental group of participants upped their confidence in this as well as “making muscles stronger” and “exercising with weights.” The groups were similar in the area of community integration.

However, it was observed that of the participants who had Down syndrome, 56% in the experimental group as opposed 16% in the control group experienced less depression. Overall, the participants who endured the health education and exercise program for the duration of the experiment felt more satisfied with their lives versus those who did not participate in this program. The results supported the hypotheses of the experimenters because the study exhibited that health education and exercise programs can not only improve the physical status of people with disabilities, but their attitude and psychosocial outcomes as well. This particular study was one of the first of its kind, but progressively more experimentation and research is being done, ultimately to help people with disabilities achieve the greatest possible satisfaction with life (4).

Physical activity is not only important to the health of children and adults. It is also crucial that elderly people avoid inactivity, especially if they have a physical or mental disability such as Down syndrome. In particular, walking programs have been known to help improve the balance, strength, and stamina of elderly people. A study was performed to analyze the effects that a six month walking program had for elderly people who have mental disabilities and Down syndrome, regarding the strength in their legs. 26 participants who had mental disabilities and a medical isokinetic system were utilized for this study that was conducted in Israel.

After a three minute warm up of walking, the participants did five repetitions of flexion and extension of the knees. This was followed by three maximal voluntary contractions. This portion of experimentation was done as the participants were seated. To test balance, the participants were asked to stand up from their seats, walk a distance of nine meters, and then walk back to the chair. The walking distance totaled 18 meters. Three times a week for 25 weeks, the participants walked on the treadmill, which was set to a low endurance level. The participants initially walked for 15 minutes during each session, which gradually became 45 minutes long. They were instructed to walk as quickly as they could while still feeling comfortable.

After each session, the participants sat down and had their blood pressures and heart rate levels. Many comparisons were made once the data from the six month long experiment was analyzed. Each of the participants made considerable improvements in their ability to endure lengthier walking distances at quicker speeds. The length strength and balance of the individuals involved with the study showed drastic improvement. It has been observed that increased morbidity of elderly people who have Down syndrome may be associated with decreased motivation and access to physical fitness programs. Empowering these adults to be physically active may lead to a slower progression of diseases, reduced falls, increased community integration, and greater satisfaction with themselves and their lives (5).

Regular physical activity is one of the most important things any individual can and should do for their health. This is especially important for people who have disabilities because they may otherwise lead more sedentary lifestyles and have increased risk of acquiring many diseases. More research and experimentation is being done at this time to observe, measure, analyze, and evaluate the significance of physical activity for people who have disabilities. Only lately has more information been compiled on the benefits of being active, aside from simply the physical. This is one of the most feasible ways to empower individuals who may feel limitations and restrictions due to their disabilities. The ultimate purpose of physical activity and exercise therapy is to encourage self efficacy and improve the quality of life for every individual.

references

additional reading:

- Riverbend Down's Syndrome Association ( very good resources here )

Bio: Because Acsah's parents immigrated to the US, and since she was born and raised in the States, she considers herself to be both 100% Indian and 100% American. Now a senior at the University of Florida, Acsah is majoring in Health Education and Behavior with a concentration in Community Health. After earning a master's degree in Public Health, she desires to utilize both her passion and education to work among those who are underserved and suffering from preventable diseases, both domestically and internationally. She enjoys spending time with family and friends, serving at church, singing, and travelling.

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