Adults with intellectual disability (ID) have decreased cardiovascular fitness and strength present with lower rates of physical activity (PA), and often have balance and functional impairments. The purpose of this study was to investigate the effect of a combined PA program (CPAP) utilizing aerobic, strength and balance training on cardiovascular fitness, strength, balance and functional measures in a controlled clinical trial. Adults with mild to moderate ID were assigned into either the intervention group (IG; n = 37) or the control group (CG; n = 29). The IG trained 3 day/week, 1 h/day over 14 weeks, while the CG did not participate in any exercise program. Cardiovascular fitness, strength, balance, flexibility and functional ability were assessed pre-post training. The IG increased cardiovascular fitness (26.8 vs. 29.3 ml kg−1 min−1), handgrip strength (19.2 vs. 21.9 kg), leg strength, and balance following the training period (p < .05). Body weight (70.1 vs. 68.1 kg) and body mass index (27.4 vs. 26.6 kg m−2) decreased (p < .05) in the IG group. The CG showed no changes in any parameter. These data suggest a combined aerobic, strength and balance exercise training program is beneficial among individuals with ID.
Adults with intellectual disability (ID), as shown by several studies, have decreased cardiovascular fitness, lower rates of physical activity (PA) and higher incidence of obesity compared to persons without ID (Baynard et al., 2008, Draheim et al., 2002b, Fernhall and Pitetti, 2001, Frey, 2004, Skowronski et al., 2009 and Temple et al., 2006). This impaired fitness is associated with several factors such as a sedentary lifestyle, possible lack of motivation and task understanding, an unhealthy diet, decreased muscle strength, hypotonia, aerobic capacity, increased fat-free mass, an increased prevalence of cardiovascular diseases and lower insulin sensitivity (De Winter et al., 2009, Flore et al., 2008, Pitetti and Boneh, 1995 and Skowronski et al., 2009).
Similar to the general population, cardiovascular disease is a problematic health concern with high morbidity and mortality rates for individuals with ID (Draheim, 2006, Patja et al., 2001 and Van den Akker et al., 2006). Furthermore, these disease rates have not declined among individuals with ID as they have compared to the general population (Draheim, 2006 and Janicki et al., 1999). One contributing factor to this increased disease risk may be the high rates of obesity among persons with ID. In the United States, between 1997 and 2000, the rate of obesity (body mass index ≥ 30.0 kg m−2) was 35% in persons with ID versus 21% in the general population (Yamaki, 2005). Related to obesity, physical inactivity and overnutrition also play an important role in cardiovascular disease risk (Sohler et al., 2009 and Van Schrojenstein Lantman-de Valk et al., 2007). Individuals with ID who participated in more frequent bouts of PA or who consumed lower dietary fat intakes lowered their risk for hyperinsulinemia and abdominal obesity by one third compared to those who participated in less frequent PA or who consumed higher fat intakes (Draheim, Williams, & McCubbin, 2002a).
This study showed that a CPAP could improve aerobic fitness, muscle strength and balance of people with ID. In addition, some positive changes in anthropometric parameters and the decrease in BP values, which together with the aforementioned improvements would imply a decrease in the risk factors associated with cardiovascular disease or metabolic disorders.
The current program differed from previous studies because it was based on aerobic, strength and balance as principal components. Specific, well structured, fun and interesting physical activity programs are necessary to promote an active lifestyle, increase work capacity, improve motor skills and decrease health risks in this population (Fernhall, 1993 and Frey et al., 2008)
In our opinion, the present findings suggest that not only aerobic training is important because in people with ID becoming older, muscle strength and balance should be trained to increase or maintain their daily-living activities and prevent or delay functional decline, risks of falls and injuries. However, more studies are needed to assess the type of PA intervention (intensity, frequency and volume) that would beneficiate most people with mild to moderate ID.
