Developing and Maintaining Physical Fitness in Adolescents with Down Syndrome

描述（由申请人提供）：美国儿童的日常体力活动（PA）远远低于现行指南，并且花费相当多的空闲时间进行久坐不动的活动（CDC，2009; Gordon-Larsen，纳尔逊和Popkin，2004）。这一评估对于我们服务不足的智力残疾（ID）儿童和青少年人群来说似乎是正确的，包括唐氏综合征（DS）（Whitt-Glover，奥尼尔和Stettler，2006）。定期和持续PA的健康益处是引人注目的。如果渐进式阻力训练与有氧运动相结合，好处可能包括肌肉力量，肌肉耐力和心血管健康的改善;控制血压;骨骼健康;降低超重/肥胖的风险;和心理健康。PA被列为2010年健康人群的“领先健康指标”。对ID儿童的研究表明，在严格控制的训练条件下，与健康相关的健身有所增加。需要转化研究开始以确定在更自然的条件下是否可以实现类似的适应性改善（例如，在社区基督教青年会），而且，重要的是，是否PA及其成果得到维持。这项拟议的研究旨在确定与等待名单对照组（WL）的参与者相比，参加16周YMCA运动干预（INT）的DS青少年是否：1）相对于基线，在8周和16周时，肌肉力量，肌肉耐力和有氧健身指数有更大的改善（主要目的）; 2）在干预后16周内保持运动行为和健身结果，并在24周和32周进行随访测量（主要目的）; 3）显示身体组成的更有利变化（无脂肪质量）和BMI，在基线、16周和32周时测量（次要目的）;以及4）在基线、16周和32周时，通过加速度计测量，在YMCA内外进行更广泛的PA。将40例年龄在16-22岁之间的唐氏综合征受试者随机分配至INT（N=20）和WL（N=20）组。措施将包括1-RM卧推和腿部推举的肌肉力量，最大重复50%的1-RM卧推和腿部推举的肌肉耐力，20米往返跑的有氧健身，生物电阻抗的身体成分，和加速度计显示平均时间在不同水平的PA。INT将提供有监督的训练和指导，在重量和有氧运动，正式的同龄人配对，并集中教育信息，保持锻炼计划和扩大PA到基督教青年会以外。我们的长期方案目标是更有效地解决ID人群中注意到的健康差距;目前的R21项目旨在为实现我们的长期目标提供基础。 公共卫生相关性：美国卫生与公众服务部已经确定了智障儿童、青少年和成年人（包括唐氏综合症患者）的主要健康差异。有必要为DS患者提供更多以社区为基础的健康促进计划，以抵消在这一服务不足的人群中观察到的慢性病风险因素升高。身体活动在《2010年健康人群》中被列为主要健康指标，其目标包括提高残疾儿童的活动水平和减少久坐行为。

DESCRIPTION (provided by applicant): Children in the US fall far below current guidelines for daily physical activity (PA), and spend considerable free time in sedentary pursuits (CDC, 2009; Gordon-Larsen, Nelson, & Popkin, 2004). This assessment appears true for our underserved population of children and adolescents with intellectual disabilities (ID), including Down syndrome (DS) (Whitt-Glover, O'Neill, & Stettler, 2006). The health benefits of regular and sustained PA are compelling. If progressive resistance training is combined with aerobic activity, benefits may include improvements in muscular strength, muscular endurance and cardiovascular fitness; control of blood pressure; bone health; reduced risk for overweight/obesity; and psychological wellbeing. PA is listed as a "leading health indicator" in Healthy People 2010. Research with children with ID has demonstrated increases in health-related fitness, but under tightly controlled training conditions. Translational research is needed to begin to determine whether similar improvements in fitness can be achieved under more naturalistic conditions (e.g., in community YMCAs), and, importantly, whether PA and its outcomes are maintained. This proposed study seeks to determine whether adolescents with DS who participate in a 16-week, YMCA- based exercise intervention (INT), as compared with participants in a wait-list control group (WL) will: 1) show greater improvements in indices of muscular strength, muscular endurance and aerobic fitness at 8 and 16 weeks, relative to baseline (primary aim); 2) maintain exercise behavior and fitness outcomes over a 16-week post-intervention period, with follow-up measurement at 24 and 32 weeks (primary aim); 3) show more favorable changes in body composition (fat-free mass) and BMI, measured at baseline, 16 and 32 weeks (secondary aim); and 4) engage in more generalized PA in and outside of the YMCA, as measured by accelerometry, at baseline, 16 and 32 weeks. Forty (40) participants with Down syndrome, ages 16-22 years, will be randomly assigned to the INT (N=20) and WL (N=20) groups. Measures will include 1-RM bench and leg press for muscular strength, maximum repetitions of 50% 1-RM bench and leg press for muscular endurance, 20m shuttle run for aerobic fitness, bioelectrical impedance for body composition, and accelerometry showing average time in different levels of PA. The INT will be provide supervised training and coaching in weights and aerobic exercise, the formal peer dyads, and focused educational messages on maintaining the exercise program and extending PA to outside of the YMCA. Our long-term programmatic goal is to more effectively address the health disparities noted in the ID population; the present R21 project was designed provide the foundation for accomplishing our long-term goal. PUBLIC HEALTH RELEVANCE: The US Department of Health and Human Services has identified major heath disparities among children, adolescents, and adults with intellectual disabilities, including those with Down syndrome. There is a need for more community-based health promotion programs for individuals with DS in order to offset the elevated risk factors for chronic disease observed in this underserved population. Physical activity is listed prominently as a leading health indicator in Healthy People 2010, and objectives include improving activity levels and reducing sedentary behavior in children with disabilities.