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)远远低于当前的指导方针，他们花相当多的空闲时间在久坐不动的追求上(CDC，2009；Gordon-Larsen，Nelson，&Popkin，2004)。这一评估似乎适用于我们服务不足的智力残疾(ID)儿童和青少年群体，包括唐氏综合症(DS)(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。如果渐进式阻力训练与有氧运动相结合，好处可能包括改善肌肉力量、肌肉耐力和心血管健康；控制血压；骨骼健康；降低超重/肥胖的风险；以及心理健康。PA被列为2010年健康人的“领先健康指标”。对患有ID的儿童的研究表明，在严格控制的训练条件下，与健康相关的健康状况有所增加。需要进行翻译研究，以开始确定在更自然的条件下(例如，在社区基督教青年会)是否可以实现类似的健康改善，以及重要的是，PA及其结果是否保持不变。这项拟议的研究试图确定，与等待名单对照组(WL)的参与者相比，参加为期16周的基于基督教青年会的运动干预(INT)的DS青少年是否将：1)在8周和16周时，肌肉力量、肌肉耐力和有氧适应指数比基线(主要目标)有更大的改善；2)在干预后16周期间保持运动行为和健康结果，并在24周和32周(主要目标)进行跟踪测量；3)在基线、16周和32周(次级目标)时，显示出更有利的身体成分(脱脂质量)和BMI的变化；以及4)在基线、16周和32周时，通过加速计测量，在青年会内外进行更广泛的PA。40(40)名唐氏综合征患者，年龄16-22岁，将被随机分配到INT(N=20)和WL(N=20)组。措施将包括用于肌肉力量的1 RM板凳和腿部按压，用于肌肉耐力的50%1 RM板凳和腿部按压的最大重复次数，用于有氧健身的20米穿梭跑，身体成分的生物电阻抗，以及显示不同PA水平的平均时间的加速测量。INT将提供关于举重和有氧运动(正式的同伴二人组)的监督培训和指导，并将重点教育信息保持锻炼计划并将PA扩展到基督教青年会之外。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力残疾儿童、青少年和成人之间的主要健康差距，包括唐氏综合症患者。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的增加。体力活动被列为2010年健康人的主要健康指标，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.