Physical Activity's Effect on the Cognitive Abilities of Young Adults with Intellectual Disabilities

This is a summary of the JSCR article,
written by Alyxandra Aldrich¹, Victoria Claypoole², Robert Pastula³, Christine Stopka³, Chris J. Hass³, Anthony Delisle³, Ann Goodman⁴
University of Florida, College of Public Health & Health Professions¹
University of Florida, College of Liberal Arts & Sciences²
University of Florida, College of Health and Human Performance³
Sidney Lanier School, Alachua County Public Schools ⁴

ABSTRACT
Individuals with intellectual disabilities (ID) are more likely to struggle with independence, have social dilemmas, and experience health obstacles when compared to individuals without disabilities. Many studies propose that exercise could be a way to enhance cognitive abilities; however, few of these studies consider populations with disabilities.

In the initial pilot study, 14 young adults (ages 17-21) with ID attended a community based exercise program for 8 weeks. The young adults were pre and post-tested using 3 subtests of the Woodcock Johnson III Test of Cognitive Abilities to explore their cognitive functioning levels. Results determined that scores on all three cognitive abilities tests improved significantly following the 8 week intervention (all, p=0.002). In conclusion, an organized exercise program may enhance cognitive abilities among young adults with ID.

INTRODUCTION
There are an estimated 4.6 million individuals in the U.S. with an intellectual or developmental disability (AAID, 2012). An individual with an intellectual or developmental disability is diagnosed before the age of 18, and has significant limitations in both intellectual functioning and adaptive behavior, such as conceptual skills, social skills, or practical skills. Quite a few of these individuals are young adults struggling to transition from school into the work force and independent living.

Current interventions to aid in this transition are repetitive and not entirely beneficial for these individuals (Hessels, 2012). We propose that exercise could be an alternative intervention. Individuals with Intellectual Disabilities (ID) could gain vocational opportunities and independence through improvement of cognitive functioning. There is evidence that physical activity has a positive effect on cognitive ability, but most of the evidence-based studies concern individuals without disabilities (Hillman, 2008).

However, adults with ID are less likely to be physically active than those without ID (Bartlo, 2011). We hypothesize that not only can physical activity improve the overall physical health for these young adults with ID, but can also improve their cognitive processes, and thus assist in life transitions.

METHODS

Participants: 14 participants from a specialized school for students with ID participated in the study (including Down syndrome, autism spectrum disorder, etc.). Each individual was classified with a mild to moderate ID based on testing prior to the intervention. The average age of participants was 19.4 (+ 1.3), and included nine males and five females. Students were selected to participate in exercise program based upon seniority, good behavior, good standing of health, and signed consent form from both parent/guardian and physician.

Exercise Intervention: The community-based exercise program was held at the University of Florida. The exercise program lasted eight weeks, and met twice a week for 50 minutes each day. The physical activity done during the program consisted of a mix between own body weight exercises (static planks, squats, etc.) and adaptive recreational sports (including obstacle courses, noodle soccer, etc.). Student's heart rates were checked periodically throughout program to ensure a moderate intensity (60-70% of max heart rate) work-out was being maintained. The cognitive measurements were taken the week before the intervention began and the week following the intervention's completion.

Measurement of Cognitive Ability: Woodcock Johnson III Test of Cognitive Abilities - The three subtests used in this were combined into a standard score of Processing Speed, or the speed of mental activity. For each subtest the participants were given 3 minutes to complete as many questions as possible.

Pair Matching (60 questions): This measures ability of perceptual speed which involves making comparisons based on rapid visual searches.

Decision Speed (40 questions): This measures the speed of semantic processing (manipulation of stimulus content) and requires one to make symbolic comparisons of concepts.

Pair Cancellation (21 rows of figures): This measures persistent attention on a cue and target. Attention and ability to focus on stimulus is an important aspect of cognitive activity.
See Figures 1-2.

RESULTS:
After pre-testing, and prior to the start of the intervention, 2 participants were excluded from the study due to problematic behavior at school; the remaining 14 participants completed the entire 10 week exercise program along with pre- and post-testing. The sample mean exercise heart rate during the intervention was 138 beats per minute (68% average max heart rate), confirming that the participants worked within the range of 60-70% of their predicted max heart rate. Performance was significantly improved on all 3 cognitive tests (all, p < 0.002). The mean percent increase in processing speed, a measure taking into account each individual's performance on the 3 subtests, was 103%. Individual and group performance on all three subtests can be found in Table 1.

DISCUSSION
Due to the heightened prevalence of inactivity and health problems among people with disabilities, it is important to convey the positive outcomes that physical activity can encourage. This study proposes that a moderate intensity, community based exercise program may improve the cognitive abilities of young adults with ID.

Because of the moderate intensity and fun nature of the exercise program, all of the participants adhered to the 8 week intervention. However, sustaining a physically active lifestyle is very difficult for individuals with ID because of many barriers (including transportation, self efficacy, etc.) (Bodde, 2009). Encouraging physical activity and enhancing cognitive functioning is essential for individuals with ID because it could help in their struggle for independence, community involvement, and overall life satisfaction.

CONCLUSION
Moderate-intensity exercise training can yield robust improvements in the cognitive functioning and aerobic fitness of young adults with intellectual disorders. These effects support the inclusion of exercise programs into the lives of young adults with intellectual disorders to promote their physical and cognitive health. The individuals of this study exercised at a moderate intensity and were able to reap significant benefits in cognition.

It is clear that exercise is beneficial for both physical and mental health, but the greatest challenge to youth with disabilities is finding ways for them to enjoy and adhere to a physically active lifestyle (Rimmer, JA and Rowland, JL, 2008). While the participants in this study could either stay in their classrooms, or choose to attend the exercise sessions, we observed a 100% adherence rate. This is likely due to the moderate intensity and enjoyable nature of our group exercise intervention.

Increasingly, persons with intellectual disorders are searching for independence, but low graduation and employment rates remain a hindrance to their success. An effective exercise therapy may catalyze their integration into society (Stopka, et al., 2008), while also significantly lowering their health care costs.

FUTURE RESEARCH:
Further research is needed to expand beyond this pilot study. Two replicate studies have already been completed, data are being analyzed, and preliminary findings show similar improvements in cognitive abilities. Larger studies are indicated, along with a qualitative analysis of the exercise intervention to reveal the participants' feelings and views towards the program (including sustainability, level of enjoyment, improvement possibilities).

ACKNOWLEDGMENTS
Special thanks is given to the Sidney Lanier School for their support, and for providing transportation to the University of Florida from Sidney Lanier. We would also like to thank Dr. Marcia Wiesel-Leery for providing the training for the cognitive testing and allowing us to use her resources. Also, we would like to thank the Stephen C. O'Connell Center staff for allowing us to use all of their facilities for the entirety of the ten week program.

references

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PHOTOS

Exercising hard, everyone participates together in this wonderful inclusive fitness program.

Our favorite game - noodle soccer. Everyone has a ball (literally) and a noodle. Goals are on all 4 sidelines. It’s maximum participation and fun for all!

Group "Silly" picture showing how well the students from UF and the students from Sidney Lanier get along so well!

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