The Effects of Virtual Zumba® in Individuals With Developmental Disabilities
Condition: Developmental Disability; Autism Spectrum Disorder; Down Syndrome; Cerebral Palsy
MeSH terms: Cerebral Palsy; Down Syndrome; Autism Spectrum Disorder; Developmental Disabilities
Study type: Interventional

Summary: 
      There are critical knowledge gaps that need to be addressed to understand the impact of
      aerobic exercise programs on relevant functional outcomes in adults with developmental
      disabilities (DD). This study will build upon previous literature by examining the impact of
      a 10-week (2x a week; 60-minutes per session) virtual adapted aerobic dance intervention
      (adapted Zumba®) in adults with DD ages 20-69 (n=58). Participants will be quasi-randomized
      to one of three groups: control (normal activities), low-tempo Zumba®, and high-tempo Zumba®.
      The quasi-randomization enables the investigators to ensure similarities in relevant
      demographic factors (e.g., disability type, age, sex) across the three groups. This design
      will enable the investigators to determine the effects of Zumba® and the impact of tempo
      level on relevant outcome measures. Participants will compete testing three times - pre-test,
      post-test, and a 4-week follow-up test - to determine the immediate and long-term benefits of
      Zumba®. Changes in functional mobility (Timed Up-And-Go), balance (Clinical Test of Sensory
      Interaction on Balance), aerobic capacity (6-minute Walk Test), and executive functioning
      (Flanker) will be assessed. During the program, participants' moderate-to-vigorous physical
      activity (MVPA) will be measured using accelerometry. Compared to the control group, the
      investigators hypothesize that both Zumba groups will show an improvement in body
      composition, balance, functional mobility, executive functioning, aerobic capacity, and MVPA
      during the program. Moreover, the investigators hypothesize that the high tempo group will
      improve body composition, balance, functional mobility, executive functioning, aerobic
      capacity, and MVPA during the program more than the low tempo.
    

Detailed description: 
      The term developmental disabilities (DD) encompasses a group of long-term disabilities that
      begin before the age of 18 years and include autism spectrum disorder (ASD), cerebral palsy
      (CP), Down syndrome (DS), intellectual disabilities (ID), and other similar disabilities.
      Currently, nearly 17% of children have a DD. Furthermore, the prevalence of DD has grown over
      the last 8 years; the prevalence of ID and DS has increased by more than 25% (from
      2009-2017), and ASD has doubled over this period. Simultaneously, the life expectancy of
      those with DS has also increased to into the sixties and for those with ID into their
      seventies creating a growing population of older adults with DD. Despite the increase in life
      expectancy, individuals with DS and ID do not live as long as typically developing
      individuals and have a lower quality of life throughout the lifespan. Therefore,
      interventions are needed to improve the health and quality of life in adults with DD.

      Individuals with DD face disproportionate physical health problems. Low cardiorespiratory
      fitness, low physical activity (PA) levels, poor functional mobility, and greater obesity.
      Together, these issues lead to secondary health conditions that contribute to early morbidity
      and reduced quality of life for the growing population of adults with DD. In fact, one study
      found that two of the leading causes of death for individuals with DD, heart disease and
      diabetes, were correlated with low levels of PA.

      Access to adapted PA and fitness programs may attenuate the risk for health problems, poor
      quality of life, and early morbidity in this population. Indeed, older adults (>50 years old)
      with ID with high fitness skills (i.e., cardiorespiratory fitness, grip strength, balance)
      have much high survival rates over a 5-year period than those with low fitness skills.
      Indeed, aerobic, strengthening, and combined exercise programs have been found to improve the
      overall health and well-being of adults (ages 18-75) with ID. Thus, there is a clear need to
      develop and implement exercise and fitness programs to promote healthy aging and reduce
      physical health disparities in this underserved population.

      Aerobic exercise programs have been found to improve cardiorespiratory fitness, strength,
      flexibility, mobility, and attention in individuals with DD. However, there are several
      important limitations that suggest the need for further study. First, many previous studies
      investigating the efficacy of aerobic programs in individuals with DD did not employ
      randomized control designs, which reduces the generalizability and increases the bias of
      study results. If there was a control group, the controls consisted of inactive controls.
      Rather, the use of active control groups helps to determine how different components of the
      exercise program (e.g., frequency, intensity, time, or type) impact outcomes. Second, few
      studies have examined the impact of aerobic exercise programs on functional mobility or
      balance and attention in adults with DD. These two variables are relevant for the ability to
      perform activities of daily living independently. Third, few studies have included a
      retention period to examine the long-term impact of aerobic exercise programs (i.e., beyond
      the immediate effects of an exercise program) in this population. Lastly, only two studies
      examined the impact of cognitively-engaging aerobic exercise programs like Zumba® in
      individuals with DD. Cognitively-engaging aerobic exercise programs may confer a greater
      impact on cognitive functions like attention compared to typical aerobic exercise programs
      (e.g., running, cycling, etc.).

      Given the limitations of previous studies, there are critical knowledge gaps that need to be
      addressed to understand the impact of aerobic exercise programs on relevant functional
      outcomes in adults with developmental disabilities (DD). This study will build upon previous
      literature by examining the impact of a virtual 10-week (2x a week; 60-minutes per session)
      adapted aerobic dance intervention (adapted Zumba®) in adults with DD ages 19.04-68.78
      (n=57). Participants will be quasi-randomized to one of three groups: control (normal
      activities), low-tempo Zumba®, and high-tempo Zumba®. The quasi-randomization enables the
      investigators to ensure similarities in relevant demographic factors (e.g., disability type,
      age, sex) across the three groups. This design will enable the investigators to determine the
      effects of Zumba® and the impact of exercise tempo. Participants will compete testing three
      times - pre-test, post-test, and 4-week follow-up test - to determine the immediate and
      long-term benefits of Zumba®. Changes in functional mobility (Timed Up-And-Go), balance
      (Clinical Test of Sensory Interaction on Balance), aerobic capacity (6-minute Walk Test), and
      executive function (Flanker) will be assessed. During the program, participants' MVPA will be
      measured using wrist-worn accelerometers.

      It is hypothesized that:

        1. Compared to controls, both adapted Zumba groups will show an increase in balance,
           functional mobility, and aerobic capacity (Group x Time Interaction). Follow-up t-tests
           will reveal a dose-dependent improvement in these outcomes between pre-test and
           post-test (HT>LT>Controls). Moreover, follow-up t-tests will reveal that the high-tempo
           group will maintain their improvements 4 weeks after the program (post-test to
           follow-up), compared to the low-tempo group and control group (HT>LT=Controls).

        2. Compared to controls, both adapted Zumba groups will show an increase in EF. Follow-up
           t-tests will reveal a dose-dependent improvement in EF from pre-test to post-test
           (HT>LT>Controls). Moreover, follow-up t-tests will reveal that the high-tempo group will
           maintain their improvements 4 weeks after the program (post-test to follow-up), compared
           to the low-tempo group and control group (HT>LT=Controls).

        3. Compared to controls, both adapted Zumba programs will exhibit greater MVPA levels
           during the program (Group main effect). A follow-up t-test will reveal a dose-dependent
           increase in MVPA (HT>LT>Controls).

        4. Compared to controls, both adapted Zumba programs will exhibit improvements in body
           composition (Group x Time interaction). Follow-up t-test will reveal that the high-tempo
           group will exhibit more improvement compared to the low-tempo group and controls (HT
           >LT>Controls).

      Methods Participants 57 individuals with DD ages 18-60 years will be recruited from three
      community day programs for adults with DD. Participants will be included if the participants
      are healthy enough to participate in exercise (based on the Physical Activity Readiness
      Questionnaire or a physician's letter), 18 years or older, and have a diagnosed DD (e.g.,
      Autism Spectrum Disorder, Down Syndrome, Intellectual Disability, etc.).

      Study Design The study will examine the impact of a 10-week (2x a week; 60 minutes per
      session) virtual adapted aerobic dance intervention (adapted Zumba®) with three groups -
      control (normal activities), low-tempo Zumba®, and high-tempo Zumba®. This quasi-randomized
      approach will enable the investigators to match the three groups on relevant demographics
      (i.e., level of function, age, and diagnosis). This design will enable the investigators to
      determine the overall effects of Zumba® and the impact of tempo level on outcomes.
      Participants will compete testing three times - pre-test, post-test, and 4-week post-test -
      to determine dose-dependent (i.e., tempo) the immediate and long-term benefits of Zumba®.

      The adapted Zumba® programs will be administered for 10-week (2x a week; 60 minutes per
      session) via HIPPA-compliant Zoom. Two certified Zumba® instructors will lead the sessions.
      Both instructors have experience working with children and adults with DD. The instructors
      will swap halfway through the program to reduce potential instructor bias in leading the
      high/low tempo sessions. Each session will consist of: a warm-up (3-5 minutes), 4-5 songs
      with instruction (40 minutes), and a cool down (5 minutes) for a total of about 60 minutes
      including rest/water breaks and time to transition. The only difference between the two
      adapted Zumba® programs will be the tempo at which the songs will be played and the number of
      times through each song. The songs for the low-tempo group will be set to 3/4-speed. The
      songs for the high-tempo group will be played at full speed; the songs in the high-tempo
      group will be repeated to ensure an equal amount of time moving for both groups. All sessions
      will be video recorded and examined for fidelity. The control group will participate in
      normal activities as part of their community day program.
    

Intervention name(s): Zumba High Tempo; Zumba Low Tempo
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The Zumba high tempo group will complete a 10-week (2x a week; 60 minutes per session) virtual adapted aerobic dance intervention (adapted Zumba®). Each session will consist of: a warm-up (3-5 minutes), 5-6 songs with instruction (40 minutes), and a cool down (5 minutes) for a total of about 60 minutes including rest/water breaks and time to transition. The only difference between the two adapted Zumba® programs will be the speed at which the songs will be played and the number of times through each song. The songs for the high-tempo group will be played at full speed; the songs in the high-tempo group will be repeated to ensure an equal amount of time moving for both groups. All sessions will be video recorded and examined for fidelity. This group will complete pre-test, post-test, and a 4-week follow-up.; The Zumba low tempo group will complete a 10-week (2x a week; 60 minutes per session) virtual adapted aerobic dance intervention (adapted Zumba®). Each session will consist of: a warm-up (3-5 minutes), 5-6 songs with instruction (40 minutes), and a cool down (5 minutes) for a total of about 60 minutes including rest/water breaks and time to transition. The only difference between the two adapted Zumba® programs will be the speed at which the songs will be played and the number of times through each song. The songs for the low-tempo group will be set to three-fourths speed. All sessions will be video recorded and examined for fidelity. This group will complete pre-test, post-test, and a 4-week follow-up.
Intervention MeSH terms: Aluminum hydroxide, magnesium hydroxide, simethicone drug combination; TEMPO
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Participants will be quasi-randomized to one of three groups: control (normal activities), low-tempo Zumba®, and high-tempo Zumba®. This quasi-randomization enables the groups to be matched on relevant demographics (disability type, age, sex). This design will enable the investigators to determine the effects of Zumba® and the impact of exercise tempo.
Masking: Single (Participant)
Primary purpose: Other
Keywords: Adaptive Exercise; Virtual Exercise; Executive Functioning; Dance