Developing and Maintaining Physical Fitness in Adolescents with Down Syndrome

描述（由申请人提供）：美国儿童远远低于当前的日常身体活动指南（PA），并且花费大量空闲时间从事久坐活动（CDC, 2009; Gordon-Larsen, Nelson, & Popkin, 2004）。这一评估似乎适用于服务不足的智力残疾儿童和青少年，包括唐氏综合症（Whitt-Glover， O'Neill, & Stettler, 2006）。定期和持续的PA对健康的好处是令人信服的。如果将渐进式阻力训练与有氧运动相结合，益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/肥胖风险；心理健康。PA被健康人2010年列为“主要健康指标”。对患有ID的儿童的研究表明，在严格控制的训练条件下，他们的健康状况有所改善。需要进行转化研究，以确定在更自然的条件下（例如，在社区ymca中）是否可以实现类似的适应度改善，并且重要的是，PA及其结果是否得到维持。本研究旨在确定参加为期16周的以YMCA为基础的运动干预（INT）的DS青少年与等候名单对照组（WL）的参与者相比，是否会：1)在第8周和第16周时，相对于基线，肌肉力量、肌肉耐力和有氧健身指标有更大的改善（主要目的）；2)在干预后16周内保持运动行为和健康结果，并在第24周和第32周进行随访测量（主要目的）；3)在基线、16周和32周时测量的身体成分（无脂质量）和BMI（次要目标）显示出更有利的变化；4)在基线、16周和32周时，通过加速计测量，在YMCA内外进行更广泛的PA。40（40）名年龄在16-22岁的唐氏综合症患者将被随机分配到INT （N=20）和WL （N=20）组。测量将包括1-RM卧推和腿推以增强肌肉力量，最多重复50%的1-RM卧推和腿推以增强肌肉耐力，20米穿梭跑用于有氧健身，生物电阻抗用于身体成分，以及显示不同水平PA平均时间的加速度计。INT将提供有监督的训练和指导，包括重量和有氧运动，正式的同伴双人组，并集中教育信息，以维持锻炼计划并将PA扩展到YMCA以外。我们的长期方案目标是更有效地解决身份证人口中存在的健康差距；目前的R21项目旨在为实现我们的长期目标提供基础。

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.