TITLE: Effects of endurance exercise and half-bath on body composition,
cardiorespiratory system, and arterial pulse wave velocity in men with intellectual
disabilities

  ABSTRACT:
[Purpose] The purpose of this study was to investigate the effects of endurance exercise
and half-bath on body composition, cardiorespiratory system, and arterial pulse wave
velocity of men with intellectual disabilities. [Subjects and Methods] Twenty-four men
with intellectual disabilities, but capable of learning, were randomly assigned to aerobic
exercise (N=8), half-bath (N=8), or control (N=8) treatment groups. Over the 12-week
treatment period, the aerobic exercise group did treadmill and stationary bicycle. The
half-bath treatment group was placed in a sitting position in a 39–40°C bath for 10
minutes. [Results] The aerobic exercise group showed a significant decrease in body fat
than those in the half-bath and control groups. In addition, there was an increase in the
respiratory system of the aerobic exercise group but no increase in the half-bath and
control groups. The arterial pulse wave velocity change was greatest in the aerobic
exercise group, but the half-bath group also showed a velocity change from that in the
control group. [Conclusion] Aerobic exercise and a half-bath can have positive effects on
improving body composition, respiratory system, and vascular function of people with
intellectual disabilities.

BODY.INTRODUCTION:
Korean government operates special schools and vocational training centers for the disabled
in Korean cities and provinces. Such programs are designed to support the attainment of a
healthy life through participation in regular physical activities. However, due to
insufficient budget and manpower, the government program cannot reach its full potential,
thus there is room for improvement. Especially, the cognitive ability of men with
intellectual disabilities is significantly lower than that of the general population, and
many disabled find it difficult to perform voluntary and/or regular physical activities1). Draheim2) emphasized the need for dietary control and physical activity in
adults with intellectual disabilities as most of whom are at risk for cardiovascular
disease. As such, many people with intellectual disabilities are weak or obese due to their
physical disabilities3). This increases
their potential for developing various geriatric diseases3). Therefore, there is a need to emphasize the necessity of regular
physical activity among the disabled. In order to develop a basic exercise program that can
lead to a healthy life for the intellectually disabled, this study investigated the effects
of endurance exercise and half-bath treatments on body composition, the cardiorespiratory
system, and arterial pulse wave velocity in men with intellectual disabilities.

BODY.SUBJECTS AND METHODS:
Subjects included 12 men from the Korea Employment Promotion Agency and 12 from the H
Welfare Foundation. Other than intellectual disability, the 24 subjects had no medically
overlapping disabilities and had no experience in performing regular exercise. The subjects
were randomly assigned to one of three groups: aerobic exercise group (N=8; age=19.3 ± 1.2
yrs; height=163.2 ± 2.6 cm; weight=65.6 ± 1.5 kg; body fat=32.3 ± 1.6%), the half-bath group
(N=8; age=18.9 ± 2.5 yrs; height=165.8 ± 1.9 cm; weight=66.8 ± 1.9 kg; body fat=33.0 ±
1.5%), and the control group (N=8; age=20.2 ± 1.1 yrs; height=162.8 ± 2.1 cm; weight=65.5 ±
1.4 kg; body fat=32.4 ± 1.1%). Subjects were not allowed to eat for 4 hours before treatment
and exercise for 12 hours before treatment4).  Bioelectrical impedance instrument (InBodyJ20, Bio-Space, Seoul, Korea) was used for
measuring the body composition. Before the exercise tolerance was estimated by using the
Balke-Ware protocol. The speed of the treadmill was fixed at 3.3 miles per hour (mph) with
an initial slope of 2%, which was increased by 1% every minute. Heart rate, respiratory, and
circulatory variables were recorded by using an electrocardiograph instrument (ECG; CH-2000,
Cambridge, Switzerland) and a gas analyzer (quark b2, Italy). In addition, the vessel
compliance was measured in a lying state by using a vessel compliance equipment (PWV 3.0-K_M
TEC, Korea).  The aerobic exercise program was performed between 50–70% HRmax. During the study treatment
period, two 15-minute exercise periods were performed within a 50-minute period 5 times a
week for 12 weeks. To ensure accurate exercise intensity during exercise, a Polar heart rate
monitor (Polxar Electro, Technogym, Finland) and the receiver (S710i, Polar, Finland) was
used.  Participants in the half-bath group were bathed five times a week for twelve weeks in the H
sauna located in D city, district Y. Half-bath group participants were placed in a sitting
position in a 39–40°C bath for 10 minutes. Bath water level was kept below the navel and
during the post-bath 5-minute rest period, the subject's body temperature was reduced for 1
minute in tepid and cold water by using a shower. Drinks were provided to prevent
dehydration. This process was repeated 3 times per day for a total bathing time of 30
minutes per day. Meanwhile, the control subjects did not participate in any exercise program
or half-bath treatment.  All data obtained in this study were analyzed by using SPSS 20.0 version (IBM, Armonk, NY,
USA). Descriptive statistics were used to assess means and standard deviations of subjects'
physical characteristics. To assess differences in the measured variables among the groups,
and by measurement period, results were analyzed by performing repeated two-way ANOVA. The
significance level was set at p<0.05. All subjects' parents were informed of the content
and purpose of the experiment and all provided written informed consent before beginning the
study. The experiment was approved by the Institutional Review Board of Mokwon
University.

BODY.RESULTS:
The results of this study are summarized in (Table
1Table 1.Blood composition, cardiorespiratory function, pulse wave velocity changeItemsGroupPre-testPost-testSourceFWeight (kg)Aerobic exercise65.6 ± 1.561.3 ± 1.6group11.475**Half bath66.8 ± 1963.1 ± 1.1time13.310**Control65.5 ± 1.466.1 ± 0.5group*time16.759***Body fat (%)Aerobic exercise32.3 ± 1.627.5 ± 1.1group5.116**Half bath33.0 ± 1.529.7 ± 1.6time7.106**Control32.4 ± 1.133.1 ± 1.0group*time9.096***VO2max (ml/kg/min)Aerobic exercise25.12 ± 1.2133.07 ± 2.37group7.680*Half bath26.18 ± 1.2027.07 ± 1.10time8.223*Control27.13 ± 1.0127.05 ± 1.00group*time9.618**HRmax (beat/min)Aerobic exercise164.51 ± 1.88171.22 ± 2.77group38.536*Half bath165.87 ± 1.05167.55 ± 1.40time43.831*Control166.77 ± 1.20166.81 ± 1.04group*time39.273**Pulse wave velocity (m/sec/height)Aerobic exercise1.63 ± 0.031.53 ± 0.06group21.181*Half bath1.62 ± 0.051.57 ± 0.03time37.193**Control1.64 ± 0.041.64 ± 0.03group*time39.760****p<0.05, **p<0.01, ***p<0.001). According to those results, body composition, maximal oxygen uptake, heart
rate, and arterial pulse wave velocity were significantly different among the groups. There
were also differences related to time of measurement and interaction.

BODY.DISCUSSION:
The results of this study showed a significant improvement of body composition in the
exercise and half-bath treatment groups. These results are consistent with those in previous
studies. Lee5) reported that when students
with learning disability engage in extracurricular physical activities, their abdominal fat
decreased markedly. Shin6) reported that
students with learning disorders who participated in basketball programs showed positive
changes in their physical health and fitness. Interestingly, the change in body composition
in this study's half-bath group would be the result of increasing the body temperature
rather than from exercise7, 8). It is assumed that the half-bath facilitated increased
blood supply to peripheral blood vessels and promoted metabolism, thereby reducing body
weight and body fat7, 8). This present study was conducted with the intellectual disability
without any disorders. However, the disabled usually have a lower flexibility and strength.
The half-bath may cause the lymphatic fluid and venous blood to shrink in the hands and
feet. It is necessary to monitor the subject's face color, eyes, and conversation at the
time of exercise program and half-bath treatment.  In this study, the maximum oxygen uptake, HRmax, and maximum ventilation were also
significantly increased after 12 weeks of treatment only in exercise group. Park1) reported that participation in aerobic
exercise programs resulted in statistically significant increases in oxygen uptake,
ventilation, and heart rate maxima among the blind and visually impaired patients. Evans and
Rosenberg9) reported that maximum oxygen
uptake increased by 15% after 16 weeks of physical training of intellectually disabled
subjects.  This study also found that the arterial wave velocity and the arterial pulse wave velocity
were significantly reduced in both the exercise and half-bath groups from that in the
control group, indicating that the blood vessel compliance was improved in the exercise and
half-bath treatment groups. The results of previous studies10, 11) are consistent with this
study. Klemsdal et al.10) reported an
increase in blood vessel compliance after exercise in subjects with atherosclerosis.
Koichiro et al.11) reported on the results
of a 16-week aerobic exercise program for middle-aged men. After the end of the program,
there was a significant increase in the vascular elasticity of the carotid artery and a
significant decrease in systolic blood pressure.  In summary, this study and previous studies indicate that regular physical activity
improves vascular function, which can prevent cardiovascular disease and increase
cardiovascular health. However, it is difficult for people with intellectual disabilities to
participate in exercise programs as they often need assistance due to their associated
physical disabilities. Therefore, more support is needed to improve the well-being of the
disabled.

Question: Compared to Control what was the result of Half bath on VO2max?
Evidence: The results of this study showed a significant improvement of body composition in the
exercise and half-bath treatment groups. 
Answer: no significant difference