Aerobic training for populations with Down syndrome

Cara Stewart

Student Physical Therapist

Central Michigan University

November 14, 2017

 Cardiovascular disease is a major mortality factor and the risk factor is 16

times higher for individuals with Down syndrome.1 Those with Down syndrome

typically have “reduced physical fitness aerobic capacity, muscle strength and

abnormal body composition, motor proficiency impairments (balance and postural

control), and physical functional limitations.”2 Individuals affected by Down

syndrome typically have more sedentary lifestyles than those without it, which is a

big reason why they have the above limitations.

Due to the high risk factor for cardiovascular disease and the sedentary

lifestyle, aerobic training is an important option for populations with Down

syndrome. Aerobic training can be used to help keep individuals active in order to

help eliminate their sedentary lifestyle. Four previous studies from 2014 to 2017

have examined the impact that aerobic training can have on populations with Down

syndrome. The purpose of this paper is to summarize and compare these four

studies, and to determine if aerobic training is recommended for individuals with

Down syndrome.

The first study consisted of 27 individuals with Down syndrome between

ages 18 and 60. Fourteen individuals were in the experimental group (Wii-based

exercise program) and 13 were in the control group. There were 2 dropouts from

the experimental group, therefore 25 individuals completed the study. The

experimental group participated in a 2-month Wii-based exercise routine that lasted

22 sessions. They did Wii exercises along with their normal occupational therapy

routine. Three 1-hour sessions were completed each week on their own or in

groups; half of each session type. The Wii Fit Balance Board allowed the individuals
to practice balance and isometric strength exercises that were provided by games

from the Wii console. The control group just did their typical occupational therapy

routine.2

The primary outcome measure was physical fitness and it was assessed by

using the Eurofit Test Battery which measures “speed of limb movement (Plate

Tapping Test), static arm length (Handgrip Test), running speed and agility (Shuttle

Run), balance (Flamingo Balance Test), flexibility (Sit and Reach Test), explosive leg

power (Standing Broad Jump), trunk strength (30-sec Sit-Ups), muscular endurance

(Bent Arm Hang), and aerobic endurance (Six-Minute Walk).”2 Secondary outcome

measures were the Timed Up & Go Test and a response speed subtest.

The most significant improvements in the experimental group were for

Handgrip Test, Sit and Reach Test, Standing Broad Jump, Six-Minute Walk, and the

response speed subtest.2 Overall, the experimental group improved in all groups

while the control group either remained unchanged or had a decrease in some

categories. Therefore, Wii training was able to help improve functional mobility,

aerobic endurance, running speed and agility, speed of limb movement, and

flexibility in patients with Down syndrome. Improvements in these areas can be

beneficial at decreasing the risk for cardiovascular disease.2

The next study consisted of 29 individuals between the ages of 12 and 20

who had Down syndrome. Fourteen were in the aerobic training group and fifteen

were in a resistance training group. There was also a control group initially,

however the individuals did not attend the second session of the study so the
control group was ultimately eliminated. Both groups participated in 50-minute

sessions and each lasted for 12 weeks.1

The aerobic group met 3 times per week and warmed up for 10 minutes,

exercised for 15 minutes on a treadmill, 15 minutes on a cycle ergometer, then

cooled-down for 10 minutes. The resistance training group did 9 exercises for 3 sets

each at 12 repetitions. The exercises were as follows; “chest press machine; leg

extension machine; lat pull down; biceps cable curl; standing leg curl with ankle

weights; cable triceps extension; calf raises with ankle weights; dumbbell front raise

and abdominal exercises.”1 There was rest time in-between each exercise. Heart rate

monitors were used to measure heart rate before and after exercises, and blood

pressure was also measured before and after exercises. After the training programs,

both groups had reductions in systolic, diastolic, and mean blood pressure.

However, there were no statistical differences for heart rate.1

The results of the study indicate that aerobic and resistance training can help

decrease blood pressure for individuals with Down syndrome. Therefore, these

types of exercise programs can be beneficial in prevention of cardiovascular

diseases. This study was unable to elicit results as to whether aerobic training is the

better option, since both groups had reductions in blood pressure. However, when

solely looking at aerobic training, it was able to produce positive results in blood

pressure for individuals with Down syndrome.1

A third study consisted of 654 participants between 8 and 46 years old. One

hundred and fifty-one of the individuals were in the Down syndrome group, 180 had

intellectual disabilities (ID) but not Down syndrome, and 323 had no disabilities.
Within these groups, each individual was either placed into the normal weight

category, overweight category, or obese category. Data collection occurred at 6

different sites; 5 cities in the United States and one in Barcelona, Spain. All sites had

identical treadmill walking protocols that were used to determine VO2peak with

indirect calorimetry.3 The protocol started with a slow walk, and then increased to a

moderate pace. Grade was then increased to 12.5% and then speed continued to

increase until the individual reached volitional exhaustion. Heart rate was recorded

throughout the test by an ECG or a heart rate monitor, and respiratory gas exchange

was measured by indirect calorimetry. BMI was also recorded for all three

populations. It is important to note that individuals with Down syndrome had the

highest BMI compared to the intellectual disabilities group and the non-disabilities

group.

The Down syndrome group had the lowest heart rate peak levels compared

to the intellectual disabilities group and the non-disabilities group. Among all

groups, the individuals in the normal weight category had the highest HRpeak, while

there was no difference between the overweight and obese categories. The Down

syndrome group also had the lowest VO2peak values compared to the other groups.

For the intellectual disabilities group and non-disabilities group, those in the obese

category had the same VO2peak values as the normal and overweight groups,

however, for the Down syndrome group, the obese individuals had lower VO2peak

values compared to the normal and overweight groups with Down syndrome.

Overall, it was determined that regardless of weight, individuals with Down

syndrome had lower HRpeak and VO2peak than those with intellectual disabilities or no
disabilities at all. However, within the Down syndrome group, obese individuals had

the lowest scores among their other peers. “These findings suggest that obesity is

associated with lower HRpeak, probably as a result of altered autonomic function

resulting in reductions in circulating catecholamines and reduced parasympathetic

function.”3 However, it was still determined overall that those with Down syndrome

had lower values whether they were obese or not. For this study, aerobic training

did not help to increase HRpeak or VO2peak for those with Down syndrome.

The final study included 15 men with Down syndrome ages 21 to 24. The

mean BMI for the group was 27.5. The individuals participated in an exercise

program 3 times per week for 6 weeks total. The protocol was a 10 minute warm-

up, 20-25 minute ride on a Monark 894 E Peak Bike cycloergometer at a work

intensity of 60-75% of the peak heart rate, and then a 10 minute cool-down.4 Heart

rates were measured with a heart rate monitor and body composition was

measured by a TANITA body composition analyzer. Twenty-four hours before and

after the training, the individuals had their venous blood samples taken. The blood

samples then underwent hematological tests, including number of RBC and RBC

indicators, and blood rheology tests.4

The results demonstrated a statistically significant decrease in RBC count

from 4.65 106/mm3 ± 0.45 to 4.32 106/mm3 ± 0.49 106/mm3.4 Furthermore, after

training, the mean BMI decreased to 27.1. The study explained that “it can be

assumed that the decrease in the number of erythrocytes may have resulted from

the process of faster ageing of red blood cells, particularly the defective ones, caused

by the high levels of oxidative stress”4 while riding on a cycloergometer. Therefore,

aerobic training on a cycloergometer was an effective way to positively influence

blood regeneration.

Two of the summarized studies had positive results for the use of aerobic

training for individuals with Down syndrome. The Wii training study helped to

improve functional mobility and aerobic endurance, and the final study with the

cycloergometer helped to increase blood regeneration. The study with the use of the

treadmill and cylcoergometer also helped to increase aerobic endurance, however,

resistance training was able to elicit similar effects. The study that looked at obesity

and HRpeak and VO2peak, was the only one to not have positive results. However, being

physically active overall is still beneficial to individuals with Down syndrome and

aerobic training is a great way to get these individuals active.

Aerobic training is therefore recommended for individuals with Down

syndrome since it can lead to increases in aerobic endurance. Individuals should

engage in an aerobic training protocol for at least 10 weeks in order to start seeing

results. It is also recommended that individuals engage in a protocol that includes

more than one exercise (i.e. running on a treadmill and riding a bike, or completing

multiple exercises with a gaming system). Participating in multiple exercises can

engage the body’s system and lead to an increase in blood regeneration and

increased endurance. These factors will be beneficial towards the prevention of

cardiovascular disease and the overall general health of populations with Down

syndrome.
 Reference List

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hemodynamic adaptations after a training program in young individuals with
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Rodriguez, E, Barbosa-Rocha, N. Wii-based exercise program to improve
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