|Year : 2016 | Volume
| Issue : 2 | Page : 124-127
Anaerobic fitness in children with Down syndrome: A pilot cross-sectional study
Asir John Samuel1, Shikha Saxena2, Vencita Priyanka Aranha1
1 Department of Pediatric Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar University, Ambala, Haryana, India
2 Department of Graduate Studies, School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
|Date of Web Publication||13-Apr-2016|
Dr. Asir John Samuel
Assistant Professor, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar University, Mullana-133 207, Haryana
Source of Support: None, Conflict of Interest: None
Clinical trial registration CTRI/2013/09/3987
Background: Children with Down syndrome (CDS) have low health-related physical fitness levels. Since, bursts of high-intensity constitute a major part of children's daily activities, it is important to determine the levels of anaerobic fitness in CDS. Aim: The aim of this study was to estimate the differences in anaerobic performance between CDS and typically developing children (TDC). Methods: Anaerobic performance was assessed in a group of twelve 8-16 year old CDS and their performance was compared to thirteen age-matched typically developing peers. The anaerobic performance of all children was measured using a field test-muscle power sprint test where children were asked to run six- 15 m sprints. The outcome measure was mean power (MP) that represented the average power output of all sprints. Results: The MP for CDS was 50.1 (25.03-75.2) W in comparison to 145.6 (114.6-176.7) W in TDC. Conclusions: The levels of anaerobic fitness are lower in CDS than in TDC. Implications: The rehabilitation strategies should emphasize strength training in adjunct to aerobic training to improve physical fitness in CDS.
اللياقة البدنية اللاهوائية عند الأطفال المصابين بمتلازمة داون: دراسة عينة مقطعية
خلفية الدراسة: الاطفال المصابون بمتلازمة داون لديهم صحة اقل تتعلق بمعدل اللياقة البدنية. ومنذ البروز القوي للمؤسسية هناك جذء كبير من الانشطة اليومية للاطفال فانه من المهم تحديد معدل اللياقة البدنية اللاهوائية للاطفال المصابين بمتلازمة داون.
الهدف: الهدف من هذه الدراسة تقييم الفرق في الأداء اللاهوائي لدى الاطفال المصابون بمتلازمة داون والاطفال المطابقين في النمو.
الطريقة: تم تقييم الأداء اللاهوائي في مجموعة من 13 طفلاً أعمارهم بين 16-18 طفلا مصابون بمتلازمة داونه وتمت مقارنتهم مع 12 طفلا تتطابق اعمارهم معهم في النمو تم قياس الأداء اللاهوائي لجميع الاطفال باستخدام حقل اختيار قوة العضلات للعدو حيث طلب من الاطفال العدو المتكرر لمسافة 15 مترا. كانت نتيجة قياس متوسط القوة والذى يمثل معدل مخرجات القوة لكل العدو.
النتائج: كان متوسط القوة للاطفال بمتلازمة داون 50.1 ( 25.03- 75.2) W بالمقارنة 145.6( 114.6- 176.7) W في الاطفال المطابقين في النمو.
الخلاصة: معدل اللياقة اللاهوائية اقل في الاطفال مع متلازمة داون بالمقارنة مع الاطفال المطابقين في النمو. التضمينات: استراتيجيات اعادة التأهيل يجب أن تعزز من قوة التدريب لترتبط بالتدريب الهوائي لتحسين اللياقة البدنية للاطفال مع متلازمة داون.
Keywords: Anaerobic, Down syndrome, fitness, muscle power sprint test, performance
|How to cite this article:|
Samuel AJ, Saxena S, Aranha VP. Anaerobic fitness in children with Down syndrome: A pilot cross-sectional study. Saudi J Sports Med 2016;16:124-7
|How to cite this URL:|
Samuel AJ, Saxena S, Aranha VP. Anaerobic fitness in children with Down syndrome: A pilot cross-sectional study. Saudi J Sports Med [serial online] 2016 [cited 2023 May 31];16:124-7. Available from: https://www.sjosm.org/text.asp?2016/16/2/124/180177
| Introduction|| |
Activity participation plays a significant role in a child's development and can have a positive impact on their quality of life and future life outcomes. 58% of children with Down syndrome (CDS) do not meet the daily activity recommendations of at least 60 min of moderate-to-vigorous intensity physical activity every day.  Physical activity in children, especially in CDS, mostly involves brief, intermittent bouts of intense movement that firmly relies on anaerobic energy systems.  Inability of the anaerobic system to meet the physical and metabolic demands is associated with a number of detrimental effects, primarily being an inability to keep up with peers during free play and sport.
CDS have low levels of muscle strength and often exhibit poor neuromuscular coordination, which further compromises their ability to perform bursts of activity. Surprisingly, anaerobic fitness during growth and development, has not received the same attention from researchers as aerobic fitness. Very few studies examined the physical activity and fitness levels in CDS, none of which estimated their anaerobic fitness. There exists only one study that estimated the reliability of the Wingate Anaerobic test (WAnT) and found that adolescents with DS exhibited low performance on the WAnT.  To understand the effect of anaerobic performance on participation in physical activities in CDS, it is important to understand how the anaerobic performance of CDS compares with that of their age-matched typically developing children (TDC). Direct measurements of the capacity of anaerobic pathways for energy turnover present several ethical and methodological difficulties. From a practical standpoint, one of the most relevant test used to measure anaerobic performance in children is the muscle power sprint test (MPST).  It is inexpensive, easily administered, and interpreted with the available reference values and can be performed in a relatively short time frame. The objective of this study was to estimate the differences in anaerobic performance between CDS and TDC aged 8-16 years using MPST.
| Methods|| |
The study protocol was reviewed and approved by Institutional Review Board (ACP/OP/2013/OL07). The study was also registered in the National Clinical Trial Registry (CTRI/2013/09/3987). All subjects were informed about the purpose and procedure of the study. An assent was taken from the subjects and a written informed consent was taken from their parents.
Twelve CDS and thirteen TDC, who could follow simple commands and run without support, participated in this study (age 8-16 years). We maintained the minimum sample size of 12 per group, as it is designed to be a pilot study.  Children with visual and hearing impairments, lower limb surgeries within the last 6 months, and those with any medical contraindications to exercise testing were not included in the study.
Muscle power sprint test
MPST is a simple field test to evaluate anaerobic performance in children who are able to walk/run.  MPST requires the child to undertake several 15 m sprints with 10 s of recovery between each sprint. Power output for each sprint is calculated using total mass (body mass) and running/propelling times, where: power = (total mass × distance 2 /time). Power can be calculated for each sprint. Peak power (PP) is defined as the highest calculated power, while mean power (MP) is defined as average power over the sprints. In this study, MP was used as an indicator of the anaerobic performance.
CDS and TDC were screened for eligibility. The anthropometric characteristics such as height and weight were recorded in both the group at the same time to avoid time discrepancy. MPST was performed in the school corridor. Two lines were taped to the floor at a distance of 15- m; cones were placed at the end of each line. Before performing the MPST, each participant performed the test at a slow speed that served both as warm-up and habituation for the participant to ensure that he/she understood how to perform the test. The warm-up was followed by a 3-min rest period. The participants were then instructed to complete six 15 m runs at maximum pace. Between each sprint, the participants are given a 10 s period to turn around and prepare for the next sprint.
The primary outcome measure was MP of anaerobic performance between CDS and TDC. Shapiro-Wilk statistics were generated to verify the assumptions of normality and homoscedasticity. As it was not verified, the descriptive statistics were reported in mean (95% confidence interval) and range. Nonparametric test of significance, Mann-Whitney U test was used to report MP of anaerobic performance between groups. Level of signiﬁcance was set at P < 0.05 for all the analyses. Statistical analyses were performed using JMP version 8 (SAS Institute Inc., Cary, NC, USA 1989-2007).
| Results|| |
All children performed MPST successfully without losing balance. The demographic characteristics of the children included in both groups with mean (95% confidence interval) and range values for age, height, and weight are given in [Table 1]. There was no significant difference (P > 0.05) in any demographic variable, i.e., age, gender, height, and weight between groups were demonstrated by Mann-Whitney U-test. The MP of anaerobic performance in TDC is 145.6 (114.6-176.7) W while CDS is 50.1 (25.03-75.2) W was displayed in [Figure 1]. There was a significant difference, at P < 0.001 between groups by Mann-Whitney U-test. Taken together, these results suggest that TDC performed better than CDS on MPST, with a significantly higher MP.
|Figure 1: Mean power of anaerobic performance by muscle power sprint test between typically developing children and children with Down syndrome|
Click here to view
| Discussion|| |
The purpose of this study was to compare the anaerobic performance of CDS who could run without support with that of their typically developing (TD) peers. CDS had impaired anaerobic performance that was 72.9% lower than that of their peers. These results are consistent with the previous studies done in adolescents with intellectual disabilities and DS as they reported a 50% decline in their anaerobic performance in comparison to their TD peers. , Children and adolescents with DS have already shown poor performances on aerobic tests.  But the anaerobic performance appears to have a greater reduction than the aerobic capacity estimated in adolescents with DS. 
As per the American College of Sports Medicine guidelines, health-related physical fitness includes body composition, aerobic capacity, muscular strength, and flexibility.  Muscle strength is an important component of muscle performance, but it is mostly neglected in rehabilitative interventions. Poor levels of muscle strength significantly contribute to the compromised anaerobic fitness levels in individuals with DS.  A review summarized the available literature on health-related physical fitness in children and adolescents with DS, and the effect of training on these variables.  Of 22 studies included in this review, only one study used strength training to improve physical fitness. Mostly, the clinical trials used aerobic training to improve physical fitness in individuals with DS. 
The results of a recent study suggest that muscle strength and physical activity are modifiable in ambulatory CDS.  Another randomized controlled trial demonstrated an improvement in the muscle strength and agility in adolescents with DS using a treadmill and virtual reality training.  Still, there is a dearth of evidence demonstrating the effectiveness of strength training interventions in CDS. We suggest that emphasizing rehabilitation programs that include anaerobic power-producing (such as running and jumping) and strength training activities might be a way to potentially mitigate the difference in anaerobic performance between children and adults with DS and their age-matched healthy peers. This study had few limitations. The generalizability of the results might be affected by the slightly less sample size and wide age range. Moreover, the participants in this study represented a convenience sample of children and adolescents with DS that may have led to some degree of selection bias. Nevertheless, this was the first study to estimate the anaerobic fitness levels in CDS and compare it to their age matched TD peers. We used a very practical and easy to administer test that can be used in future in CDS.
| Conclusion|| |
We conclude that anaerobic performance is largely decreased in CDS when compared to TDC. Rehabilitation strategies in CDS should emphasize a lot on enhancing both aerobic and anaerobic components of their performance.
Special thanks to all the children who participated in the study and to the Headmistress of Chethana Special School, Karkala, Karnataka, India and to the Headmaster of Jain English Medium School, Moodabidri, Karnataka, India for their kind cooperation. A part of the study were presented in, a) Stride-13, International Physiotherapy Conference, organized by Saveetha college of physiotherapy, Saveetha University, Chennai, India on 18 th and 19 th October, 2013. b) PGCON-2, National Physiotherapy conference, organized by JSS college of Physiotherapy, Mysuru, India on 21 st and 22 nd November, 2015.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Department of Health and Ageing. Active kids are healthy kids. Australia′s physical activity recommendations for 5-12 year olds. Publication no. PHY 06. DoHA: Canberra; 2004.
Bailey RC, Olson J, Pepper SL, Porszasz J, Barstow TJ, Cooper DM. The level and tempo of children′s physical activities : a0 n observational study. Med Sci Sports Exerc 1995;27:1033-41.
Guerra M, Gine-Garriga M, Fernhall B. Reliability of Wingate testing in adolescents with Down syndrome. Pediatr Exerc Sci 2009;21:47-54.
Verschuren O, Takken T. The muscle power sprint test. J Physiother 2014;60:239.
Julious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharm Stat 2005;4:287-91.
Chia YH, Lee KS, Teo-Koh SM. High intensity cycling performances of boys with and without intellectual disability. J Intellect Dev Disabil 2002;27:191-200.
Guerra M, Pitetti KH, Fernhall B. Cross validation of the 20-meter shuttle run test for adolescents with Down syndrome. Adapt Phys Activ Q 2003;20:70-9.
González-Agüero A, Vicente-Rodríguez G, Moreno LA, Guerra-Balic M, Ara I, Casajús JA. Health-related physical fitness in children and adolescents with Down syndrome and response to training. Scand J Med Sci Sports 2010;20:716-24.
Heyward V. Advanced Fitness Assessment and Exercise Prescription. 5 th
ed. Champaign, Illinois: Human Kinetics; 2006.
Shields N, Taylor NF, Wee E, Wollersheim D, O′Shea SD, Fernhall B. A community-based strength training programme increases muscle strength and physical activity in young people with Down syndrome : a0 randomised controlled trial. Res Dev Disabil 2013;34:4385-94.
Lin HC, Wuang YP. Strength and agility training in adolescents with Down syndrome : a0 randomized controlled trial. Res Dev Disabil 2012;33:2236-44.