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Down Syndrome

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steph ess

on 23 October 2016

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Transcript of Down Syndrome

• Use of reliable outcome measures for each component of exercise class
6MWT, SDTSB, HHD, modifed BORG RPE

• Emphasis on balance, cardiovascular and strength exercise components for this population with importance of warm up and cool down

• Provided a friendly and engaging environment to address common barriers to physical activity
Down Syndrome
Genetic disorder caused by an extra copy or part on the 21st chromosome

Common issues
Balance and coordination issues
Decreased strength
Low aerobic capacity
Low maximal heart rate
Congenital heart defects
Cognitive-social issues

Structured exercise class may promote physical activity and help manage health issues
1. Improve cardiovascular function, strength, balance and coordination

2. Fun and engaging class

3. Supportive social environment
Environment
Stimulating and fun environment

Closed environment
Minimal external influences

Engaging music

Social interactions

Building self-confidence

Supportive and encouraging
Aims of class
Image by Tom Mooring
Participants
Children with DS aged between 8-12 years old

Must be independent and able to follow commands

Precautions and contraindications:
Hypermobility
Ligamentous laxity
Underdeveloped cardiovascular or respiratory system
Poor balance and perceptual difficulties
FITT-VP Principles
Frequency:
3-5 days/week

Intensity:
Initially 30-50% of MHR, increasing to 60-75% over the course of the program

Timing:
10 mins warm-up, 25 mins exercise, 10 mins cool down

Type:
Cardiovascular, strength, balance

Volume
Cardiovascular: > 100 kcal per week
Strength: 3 x 8-12 reps

Progress:
Increase amount of aerobic exercise
Increase repetitions and weights for strength exercise
Increasing number of classes per week
Class Components
Balance
Dynamic tasks in a fun circuit
Equipment: printed images, tape, long stick, two chairs/tables

Cardiovascular
Dancing and musical statues
Equipment: music player, appropriate music for children

Strength
Upper and lower body exercises
Equipment: swiss balls
Warm up
component
Balance
Component
Cool down
Component
Key Learnings
Reflection
and Appraisal
Strengths
• Fun, engaging environment suitable for children with DS
• Cost effective
• Easy to apply in clinical and community settings
• Exercise program specific for children with DS
• Progress determined with use of OMs

Limitations
• Class not tailored to each child
• Only suitable for children who meet pre-requisite criteria (i.e. be cognitively aware of their bodies)
Glossary
DS Down Syndrome
MHR Max Heart Rate
Reps Repetitions
Kcal Kilocalories
Mins Minutes
OMs Outcome Measures
6MWT Six minute walk test
SDTSB Static and dynamic timed standing balance test
HHD Hand held dynamometer
RPE Rate of Perceived Exertion
FITT-VP Frequency, Intensity, Time, Type - Volume,
Progress

References
Cardiovascular
Component
Strength
Component
Exercise for
Down Syndrome Children

Stefanie Agostino, Dasom Kim, Stephanie Skaras, Kristine Bordador, Russell Jones, Adam Plausinaitis
1. Galli, M., Rigoldi, C., Brunner, R., Virji-Babul, N., & Giorgio, A. (2008). Joint stiffness and gait pattern evaluation in children with Down syndrome. Gait & Posture, 28502-506. doi:10.1016/j.gaitpost.2008.03.001
2. Pitetti, K., Baynard, T., & Agiovlasitis, S. (2013). Children and adolescents with Down syndrome, physical fitness and physical activity. Journal of Sport and Health Science, 2(1), 47-57.
3. Archana, R., & Mukilan, R. (2016). Beneficial Effect of Preferential Music on Exercise Induced Changes in Heart Rate Variability. Journal of Clinical and Diagnostic Research : JCDR, 10(5), CC09-CC11. doi: 10.7860/JCDR/2016/18320.7740
4. Shields, N., Synnot, A. J., & Barr, M. (2012). Perceived barriers and facilitators to physical activity for children with disability: a systematic review. Br J Sports Med, 46(14), 989-997. doi: 10.1136/bjsports-2011-090236
5. Lotan, M. (2007). Quality physical intervention activity for persons with Down syndrome. ScientificWorldJournal, 7, 7-19. doi: 10.1100/tsw.2007.20
6. Villamonte, R., Vehrs, P., Feland, B., Johnson, W., Seeley, M., & Eggett, D. (2010). Reliability of 16 balance tests in individuals with down syndrome. Perceptual and Motor Skills, 111(2), 530-542.
7. Gupta, S., Rao, B. K., & S, D. K. (2011). Effect of strength and balance training in children with Down's syndrome: a randomized controlled trial. Clin Rehabil, 25(5), 425-432. doi: 10.1177/0269215510382929
8. Tsimaras, V., & Fotiadou, E. (2004). Effect of training on the muscle strength and dynamic balance ability of asults with down syndrome. Journal of Strength and Conditioning Research, 18(2), 343–347.
9. Pitetti, K., Baynard, T., & Agiovlasitis, S. (2013). Children and adolescents with Down syndrome, physical fitness and physical activity. Journal of Sport and Health Science, 2(1), 47-57.
10. Archana, R., & Mukilan, R. (2016). Beneficial Effect of Preferential Music on Exercise Induced Changes in Heart Rate Variability. Journal of Clinical and Diagnostic Research : JCDR, 10(5), CC09-CC11. doi: 10.7860/JCDR/2016/18320.7740
11. Casey, A. F., Wang, X., & Osterling, K. (2012). Test-retest reliability of the 6-minute walk test in individuals with Down syndrome. Arch Phys Med Rehabil, 93(11), 2068-2074. doi: 10.1016/j.apmr.2012.04.022
12. Chen, C., Ringenbach, S. R., Snow, M., & Hunt, L. M. (2013). Validity of a pictorial Rate of Perceived Exertion Scale for monitoring exercise intensity in young adults with Down syndrome. International Journal Of Developmental Disabilities, 59(1), 1-10. doi:10.1179/2047387712Y.0000000005
1,2
Class schedule
3 times a week over 6 weeks

45 minute class

Maximum 6 participants per class

Run by new grad physiotherapists
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4
Recommendations and Implementation
5
6,7
8
Physician consent
Consider precautions
Periodic monitoring with OM
Implementation using FITT-VP principles
Safe progressions/modifications
For use in a hospital setting
9
10,11,12
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