# Exercise as it relates to Disease/Game Time: Exergames and Improving Fitness in Adults with Down syndrome

The following is a review of the journal article "Wii-based exercise program to improve physical fitness, motor proficiency and functional mobility in adults with Down syndrome" by V. Silva, C. Campos, A. Sá, M. Cavadas, J. Pinto, P. Simões, S. Machado, E. Murillo-Rodríguez, N. Barbosa-Rocha(2017)

## What is the background to this research?

Down syndrome (DS) is a condition that is caused by a duplicate chromosome, specifically T21. Persons who suffer from DS are shown to have a multitude of both physical and intellectual impairments. Some of the symptoms include functional impairment, muscle imbalance, poor muscle tone, weak muscle strength and low cardiovascular fitness. These impairments are shown to leave DS sufferers at a higher risk of all-cause mortality and cardiovascular diseases . Exergames are a relatively new intervention most commonly for encouraging persons to participate in physical activity. This trending platform has shown promising results for improving physical activity (PA) levels and improving cardiovascular fitness in previous studies

## Where is the research from?

This study was conducted by MENCAP, The International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons. Participants were recruited from The Center for Occupational Activities in Areosa of the Portuguese Association of Parents and Friends of the Mentally Disabled Citizens of Viana do Castelo and Cooperative for Education and Rehabilitation of Inadvertent Citizens of Guimarães1. All findings were published in the Journal of Intellectual Disability Research. The article is free for public reading.

## What kind of research was this?

This article provides quantitative research through a randomized control groups. Data was compiled from pre-test and post-test for both the experimental group and the control group. Through quantitative testing, a numerical value to show any significant changes between groups, as well as pre and post intervention1.

## What did the research involve?

Participants An initial group of 32 adults (18years- 60years) diagnosed with DS were recruited from occupational centers1. Eligibility was assessed for participation in the study. A total of 10 persons were excluded. The remaining participants were then randomly allocated into two groups, an experimental group, which receive the intervention, and a control group, which does not receive any treatment. During the testing protocols and follow up period four participants withdrew from the study. Measures tested A number of measures were taken to compare pre and post testing (refer to Table 1. Measures Obtained). The measures collected can be categorized into three groups, Anthropometric Measures, Physical Fitness Measures and Motor Efficiency Measures. Procedures The experimental group received a two-month exercise program consisting of three one hour sessions per week. Sessions were done utilizing a Wii gaming system and selected accessories adaptable to the system1. Several games were played to allow participants to perform balance, isometric strength and aerobic endurance exercises. The control group were only required to complete their normal daily activities including usual treatment, vocational rehabilitation, life skills training and art-related activities. Due to the small sample size finding significant results in some of the measurements taken. This study comments the use of other known testing protocols for persons diagnosed with intellectual disabilities. Further studies are needed to develop normative data to compare results and determine significant findings.

##### Table 1. Measures Obtained

| Anthropometric Measures | Body Weight Body Mass Index (BMI) Body Fat % Visceral Fat Muscle mass Waist Circumference |
| Physical Fitness Measures | Plate tapping test (speed of Limb movement) Handgrip Test (static arm strength) Shuttle Run (Running speed and agility) Flamingo Balance Test Sit and reach (Flexibility test) Standing broad jump (Explosive leg power) 30-sec Sit-ups (Trunk strength) Bent Arm Hang (Muscular endurance) Six-Minute Walk (Aerobic endurance) |
| Motor Efficiency Measures | Beanbag Overhead Throw (Right hand coordination) Beanbag Overhead Throw (Left hand coordination) Bruininks-Oseretsky Response Speed subtest (Motor Proficiency) Timed Up and Go test (Functional Mobility) |

## What were the basic results?

The study found that participants of the experimental group showed significant differences between groups. The experimental group showed improvements through most of the initial measures obtained however the control group showed no improvement or worsened over duration of the study. Results show active interaction with the exergames were helpful in increasing outcome measures and thereby improving quality of life for DS participants. Due to the lack of research including exergames and adult DS sufferers, further research utilizing exergames would be needed for comparison to conclude more significance in this study’s findings.

## What conclusions can we take from this research?

Due to the nature of physical limitations suffered by persons with DS, exercise, when used to improve quality of life, appears to make vast improvements. This is not only on fitness levels and reducing the risk of decline or disease, but for day to day life. The exergame programs show great promise providing useful insights into the capability of improving life for disability sufferers.

## References

* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Silva V, Campos C, Sá A, Cavadas M, Pinto J, Simões P et al. Wii-based exercise program to improve physical fitness, motor proficiency and functional mobility in adults with Down syndrome. Journal of Intellectual Disability Research [Internet]. 2017 [cited 16 September 2017];61(8):755-765. Available from: http://onlinelibrary.wiley.com/doi/10.1111/jir.12384/full
* ↑ Ilkım M, Özdemir M, Tanır H. Evaluation of some physical and motoric characteristics of athletes with down syndrome. SHS Web of Conferences. 2017;37:01030.
* ↑ Shannon D. R. Ringenbach, Simon D. Holzapfel, Pamela R. Bosch, Lauren M. Hunt, Michelle Snow. Physical Activity and Body Composition Relate to Cardiorespiratory Fitness Independently in Young Adults with Down Syndrome. Journal of Sports Science. 2017;5(2)
* ↑ Wee S, Pitetti K, Goulopoulou S, Collier S, Guerra M, Baynard T. Impact of obesity and Down syndrome on peak heart rate and aerobic capacity in youth and adults. Research in Developmental Disabilities. 2015;36:198-206.
* ↑ COWLEY P, PLOUTZ-SNYDER L, BAYNARD T, HEFFERNAN K, JAE S, HSU S et al. Physical Fitness Predicts Functional Tasks in Individuals with Down Syndrome. Medicine & Science in Sports & Exercise. 2010;42(2):388-393.
* 1 2 van Diest M, Lamoth C, Stegenga J, Verkerke G, Postema K. Exergaming for balance training of elderly: state of the art and future developments. Journal of NeuroEngineering and Rehabilitation. 2013;10(1):101
* 1 2 O'Loughlin E, Dugas E, Sabiston C, O'Loughlin J. Prevalence and Correlates of Exergaming in Youth. PEDIATRICS. 2012;130(5):806-814.