Exercise as it relates to Disease/Positive effects of strength training on people with down syndrome
What is the background to this research?
Persons with Down Syndrome have significantly lower levels of upper body and lower body strength than people without the disorder.  This lowered strength compared to their peers without the disorder could potentially impact their likelihood for employment and impact greatly on their lives. Strength training can have numerous benefits on an individual's life including: increased bone density, improved functional strength for daily tasks, reduced depression, and being able to lower risk factors for several chronic diseases such as heart disease  it is therefore important to be able to safely say if it is effective for persons with Down Syndrome. Some studies have been able to show persons with Down Syndrome can elicit positive outcomes from varying forms of exercise such as gains in physical fitness and muscular strength  what these studies on Down Syndrome failed to show, and the goal of the critiqued study was whether these gains in physical attributes had a carry over to functional tasks for the individual.
Where is the research from?
Nora Shields has conducted numerous studies into the validity and impacts of physical activity on people with Down Syndrome, the number of articles she has written clearly demonstrates her knowledge and reputation in the field. The author has also been a part of several papers which wrote about topics including: results of physiotherapy interventions after breaking limbs, exercising to improve symptoms of diabetes mellitus and exercise reducing symptoms of fatigue in cancer survivors. These ranging topics show the authors impact and validity in various fields of research. Research was carried out at the Musculoskeletal Research Centre and the School of Physiotherapy, La Trobe University, Melbourne, Australia, and was published in the Archives of Physical Medicine and Rehabilitation, both have reliable reputations.
What kind of research was this?
The type of study being conducted was a randomised control study, each participant of the study had Down Syndrome and was randomly allocated to either an exercise intervention group, or a control group which continued with their normal lives. A block randomisation method was used to determine participants of each group, this was done in concealed fashion to improve validity of the trial. How the participants were selected and study design took out any bias of the study thus increasing reliability of results shown.
What did the research involve?
The research involved participants either being in a control group where they carried out their usual lives, or being in a progressive resistance training intervention group, both lasting 10 weeks. Important measures which were taken include the two groups being assessed at baseline and post intervention to be able to compare results of intervention and control group to determine whether there were notable differences. The resistance training undertaken involved two training sessions a week which included a six exercise circuit, three exercises being for upper body and three for lower body, the training was prescribed in accordance with the ACSM  When conducting the post intervention testing on participants, the assessors were blind to the group allocation and had no involvement in the study or training either which added to the validity of the study, if these measures weren't taken it could jeopardise study findings. Limitations of the study may have included the size of the study which was relatively small, thus significant changes needed to be seen to show an effect. Also the length of the study could be questioned, for significant gains in strength adaptations the study could've gone for longer if possible.
What were the basic results?
Table 2 in the link below shows results in the discussed study https://www.archives-pmr.org/article/S0003-9993(08)00282-7/fulltext The studies main important finding was that after the 10 week exercise intervention upper body muscular performance significantly increased in both 1RM strength and endurance. Lower body strength and endurance showed no significant changes during the study. A decrease in time for functional shelf stacking task was also observed during the study.
What conclusions can we take from this research?
Due to the results shown, the conclusion can be made that resistance training is likely to be a safe and effective manner of exercise for improving persons with Down Syndromes muscular endurance and also the ability to perform some functional daily tasks. Further research may be needed to determine why more significant results were demonstrated in upper body outcomes versus lower body, this could be due to the time of the study, intensity of exercises or even specific exercises selected. A more recent systematic review was undertaken which looked at reduced exercise capacity in Down Syndrome, some of the causes of this were found to be a reduced vo2 peak in individuals with Down Syndrome, and also poorer exercise economy due to altered gait.  The review found that a combination of aerobic and resistance style training may be the most beneficial at increasing persons with Down Syndromes exercise capacity and their physiological functioning.
Resistance training appears to be a safe and effective method of strengthening individuals with Down Syndrome and improving their exercise tolerance. When undertaking exercise an individual should exercise in accordance with guidelines by the ACSM and also potentially with supervision from a qualified trainer to ensure safety and correct technique. Group training sessions and a good relationship with their trainer could be useful in strengthening the clients support network and adherence to the exercise program. With vo2 peak being lower in people with Down Syndrome it may be beneficial to ease into the aerobic training and not to increase intensity or volume straight away, also with impaired gait, strengthening of leg musculature or even walking/running technique work may be beneficial. For learning more about Down Syndrome readers may be interested in visiting https://www.downsyndrome.org.au/advocacy.html as it has advice regarding education, employment and sporting opportunities for the Down Syndrome community. Finally, a study looked at the barriers to exercise relevant to youth with Downs Syndrome found that people with the disorder were much more likely to engage in fun, unstructured type activities and were more likely to participate with support from parental networks or social interactions 
Add in the references using this code
- KH Pitetti, Arch Phys Med Rehabil. 1992 Sep;73(9):847-50, Isokinetic arm and leg strength of adults with Down syndrome: a comparative study.
- R Seguin, M Nelson, American Journal of Preventive Medicine, Volume 25, Issue 3, Supplement 2, October 2003, Pages 141-149
- JH Rimmer, T Heller, E Wang, I Valerio, Improvements in physical fitness in adults with Down syndrome, Am J Ment Retard. 2004 Mar;109(2):165-74.
- WJ Kraemer, et al, American College of Sports Medicine position stand. Progression models in resistance training for healthy adults, Med Sci Sports Exerc. 2002 Feb;34(2):364-80.
- G V Mendonca, Reduced exercise capacity in persons with Down Syndrome: cause, effect, and management, Ther Clin Risk Manag. 2010; 6: 601–610
- Samantha J. Downs, Zoe R. Knowles, Stuart J. Fairclough, Natalie Heffernan, Sarah Whitehead, Sofie Halliwell, Lynne M. Boddy. (2014) Exploring teachers’ perceptions on physical activity engagement for children and young people with intellectual disabilities. European Journal of Special Needs Education 29:3, pages 402-414.
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