اثرات یک برنامه ورزشی بر اضطراب در بزرگسالان مبتلا به معلولیت ذهنی

Although high anxiety is common in people with intellectual disabilities (ID) and the anxiolytic effects of exercise have been systematically recognised in clinical and non-clinical populations, research is scant concerning the role played by exercise on anxiety in people with ID. The purpose of this study was to investigate the effects of a 12-week exercise programme on anxiety states in a group of adults with ID. Twenty-seven individuals with mild to moderate ID were randomly assigned to an exercise group or a control group. The Zung Self-Rating Anxiety Scale adapted for individuals with ID and the State-Trait Anxiety Inventory form Y were used to assess trait and state anxiety. In comparison with the control group, the anxiety scores of people in the exercise group decreased significantly over time.

People with intellectual disabilities (ID) are often reported as having high levels of anxiety (Esbensen et al., 2003 and Sravakaki and Lunsky, 2007). Anxiety is characterised by the experience of excessive worry in a number of life domains which appears difficult to control. It is typically accompanied by agitation, feelings of tension and the activation of the automatic nervous system and can have detrimental effects on the skills, performance and daily living functions of ID people (Sravakaki, 1999). Despite the prevalence rate of ID that has been estimated at approximately 1% (American Psychiatric Association, 2000) and the well-recognised risk of high anxiety in this population, research on the assessment and treatment of anxiety in ID individuals has lagged behind that related to the general population (Hagopian & Jennet, 2008). Physical activity has been widely recognised as an effective strategy in the prevention and treatment of anxiety; regular physical activity and participation in exercise programmes have been shown to reduce both state and trait anxiety and to protect individuals against the onset of anxiety disorders and symptoms (O’Connor et al., 2000 and Physical Activity Guidelines Advisory Committee, 2008). Wipfli, Rethorst, and Landers (2008) conducted a meta-analysis on the anxiolytic effect of exercise mainly in trials involving non-clinical participants, highlighting that exercise is slightly better at reducing anxiety compared to other treatments (effect size = −0.19). Exercise was more effective than stress management education, slightly more effective than stretching and yoga, group therapy, relaxation and meditation, and as effective as cognitive behavioural therapy. Only pharmacological therapy had a small greater effect than exercise. Wipfli et al. (2008), by analysing the role of the duration of the exercise intervention as a moderating variable, found significance for both acute bouts of exercise and exercise interventions lasting 4–15 weeks (effect sizes varied from −0.39 to −0.59). Exercise was also seen to significantly decrease anxiety in different clinically defined populations; positive results have been reported in people with cardiovascular diseases (Duarte Freitas et al., 2011), cancer patients (Mehnert et al., 2011), schizophrenic patients (Vancampfort, Probst, et al., 2011) and people with anxiety disorders (Strohle, 2009 and Taylor, 2000). Physical activity is extensively seen to have beneficial effects on mental health in the general population (Penedo & Dahan, 2005), while in individuals with ID it is more likely that physical activity patterns go unnoticed or are not studied because these people are generally not included in large-scale population studies (Temple, Frey, & Stanish, 2006). Nevertheless, published literature suggests that the majority of people with ID are unfit, engage in low levels of daily physical activity and adopt sedentary behaviours (Fernhall and Pitetti, 2001, Graham and Reid, 2000 and Rimmer, 2000). The consequence is that high rates of morbidity and mortality related to hypoactive-associated diseases are quoted in this population (Sutherland, Couch, & Iacono, 2002). Despite the low rate of people with ID regularly engaging in physical activity, the positive effects of participating in physical activity, exercise programmes and sport have been reported in this population (Bartlo and Klein, 2011, Frey et al., 2008, Guidetti et al., 2010 and Rimmer et al., 2010). Physiological, psychological and relational positive outcomes have been described. Functional and musculoskeletal health, such as walking capacity, muscular endurance and strength, flexibility, cardiorespiratory health and functional independence, are the most commonly targeted outcomes (Rimmer et al., 2010). Improvements in quality of life, increased well-being, reduction of maladaptive behaviour, improved cognitive aspects, and amelioration in mental health were noted in different studies (Carmeli et al., 2005 and Elliot et al., 1994). Improved social relationships and increased self-esteem are reported in studies on sport participation (Guidetti, Franciosi, Emerenziani, Gallotta, & Baldari, 2009). To the best of our knowledge, only one previous study on the effectiveness of exercise programmes on reducing anxiety in adults with ID has been carried out (Carmeli, Barak, Morad, & Kodesh, 2009). The authors randomly assigned 24 individuals suffering from mild ID and anxiety to one of three groups (aerobic training, physical leisure activity and control). After a 6-month period the participants in the aerobic and leisure groups reported a significant reduction in anxiety. Starting from this evidence and considering the fact that anxious responses represent a serious problem for individuals with ID, the purpose of this study was to evaluate the effects of a short-term (12 weeks) exercise programme on anxiety states in a group of adults with ID.

The present study reported that a short-term exercise programme could reduce anxiety states in people with ID more than a sedentary activity. Results support the notion that exercise could be considered to be a valid strategy to promote mental health in people with ID. Moreover, implementing lifestyle interventions based on physical activity could be a cost-effective strategy in promoting individual health and wellbeing (Verhaeghe, De Maeseneer, Maes, Van Heeringen, & Annemans, 2011). Future research should include a follow-up evaluation to assess whether improvements in anxiety are maintained after a period without exercise. Another important direction of the research could be focused on evaluating which mechanisms or variables are more involved in the reduction of anxiety levels during and after exercise.