Course: Sports Management & Coaching

Module: Adapted Physical Activity

Physical Activity Prescription for People with Intellectual Disabilities

Down Syndrome

Thady McKeever B00146231

Submission Date: Friday 17th Nov 2023

Word Count: 2,200
 ASSIGNMENT DECLARATION FORM

Lecturer: Ronan Mcgann

Module Name: Adapted Physical Activity

Date of Submission: 17/11/2023

I declare that the work contained in this submission is our own work and has not been taken
from the work of others. Any sources cited have been acknowledged within the text of this
submission.
We have read and understood the policy regarding plagiarism in TU Dublin.

Student Names/Numbers: Student Signatures:

Thady McKeever B00146231
 Introduction
Down syndrome is a chromosomal condition that occurs when an individual has an extra copy of
chromosome 21. It is named after a British physician John Langdon Down, who first described
the syndrome in 1866. This condition has a profound impact on both the physical and cognitive
development of individuals, leading to distinct characteristics and challenge. For centuries,
people with Down syndrome have been alluded to in art, literature, and science. It wasn’t until
the late nineteenth century, however, that John Langdon Down, published an accurate description
of a person with Down syndrome. It was this scholarly work, published in 1866, that earned
Down the recognition as the “father” of the syndrome (Buckley, 2022).
The purpose of this document is to recognize that each person with Down syndrome is unique
and why the importance for preparation is vital. The syndrome manifests itself differently in each
individual. Despite the challenges they may face, people with Down syndrome often lead
fulfilling lives, contributing to their communities in various ways. Designing a physical activity
prescription for individuals with Down syndrome requires a personalized approach that considers
their unique physical characteristics, health conditions, and potential challenges. Engaging in
regular physical activity can bring a variety of benefits to individuals with Down syndrome,
including improved cardiovascular health, muscle tone, and overall well-being. However, it's
crucial to tailor the exercise plan to their individual needs and abilities. In the following
document I will discuss and talk you through these 8 general guidelines I have set for a thorough
and successful Physical Activity Prescription for people with Down Syndrome.

1. Consultation with Healthcare Professionals

2. Cardiovascular Exercise
3. Strength Training
4. Flexibility and Mobility
5. Balance and Cooridation
6. Fun and Social Activities
7.Safety Considerations
8. Indivindisualsed Approach

To being with Down Syndrome has some main characterises which make up the intellectual
disability. The first being
1. Intellectual Disability as an Overall basic

Down syndromes will most likely have mild to moderate intellectual disabilities. To be noted
there will be considerable difference in cognitive abilities among people with Down
Syndrome.
2. Physical Features

Often Down Syndromes will have distinct facial features which may include a flat facial
profile, almond shaped eyes, a protruding tongue and small nose. Often with a low muscle
tone known as hypotonia which can affect motor development.

3. Delay in Growth
Down syndrome can have effects on basic growth in children, for example on height and weight.

4. Cardiac Abnormalities

Around 40-50% of Down Syndromes may have congenital heart defects, which will often need
for medical intervention

5. Gastrointestinal Issues

This means an problem with the digestive system for example gastrointestinal or celiac disease
may me evident in a Down Syndrome.

6. Immune System Vulnerability

Down Syndromes will often be prone to issues such as ear infections or respiratory problems as
well as a number of immune related conditions

7. Speech and Language Delay

Simple language and speech development may be prolonged and delayed and an aid of speech
therapy often is beneficial.

8. Joint and Muscle Issues

Already mentioned Hypotonia (low muscle tone) can have a huge impact on fine motor skills,
leading to a delay in learning skills such as walking or crawling a young age.

9. Behavioural Characteristics

There can be potential for a wide range of cognitive abilities among Down Syndromes, but most
show a good level and strength in social aspects and interpersonal skills. However issues such as
attention may be present.

10. Risk of Certain Health Conditions

People with Down Syndrome will have an increased chance of certain health issues such as
thyroid disorders, leukaemia and early onset Alzheimer’s Disease.

As Silverman in 2007 sums up this overall personality characterises of a person with down
syndrome “It affects both physical and cognitive development and produces a characteristic
phenotype, although affected individuals vary considerably with respect to severity of specific
impairments. Studies focusing on the cognitive characteristics of Down syndrome were
reviewed, and while performance in most areas could be predicted based upon overall
intellectual disability, relative weaknesses were consistently found to be associated with
expressive language, syntactic/morphosyntactic processing, and verbal working memory. This
profile of uneven deficits could result from a failure to develop typically automatic processing
for speech perception and production, and this possibility is discussed along with its implications
for intervention” (Silverman, 2007).

After some research on the physical education background and training aids on people with
Down Syndrome vie evaluated that many children with Down Syndrome do not achieve the daily
amount of necessary physical activity. I found a study on to why this was the case and to explore
the barriers and facilitators to physical activity on Down Syndromes. There were 18 deep
interview conducted with an overall of 20 parents being 16 mothers and 4 fathers. These were all
parents of children with down syndrome aged between 2 and 17 to examine on which factors will
facilitate physical activity and what factors are just pure barriers of activity for their children in
particular. The participants were found through an organisation disability group that pushes the
importance of people with Down Syndrome and their families. All of these interviews were
recorded, written down, coded and analysed by two serrate professionals on this field.

“Four themes on facilitators of physical activity were identified: (1) the positive role of the
family; (2) opportunity for social interaction with peers; (3) structured accessible programmes
that make adaptations for children with Down syndrome; and (4) children who were determined
to succeed and physically skilled. Four themes on the barriers to physical activity were also
identified: (1) characteristics commonly associated with Down syndrome; (2) competing family
responsibilities; (3) reduced physical or behavioural skills; and (4) a lack of accessible
programmes” (Shields, 2011).
The results aspect highlighted by Shields himself echo the importance of the families themselves
who often have a good indication of how much physical activity their down syndrome child will
need and the effect that the common characteristics associated with Down Syndrome can have on
minting an active lifestyle in an overall basis. However it needs to be noted that further research
will need to concentrate on some ways to encourage physical education and by not making a
chore such as an emphasis on social interaction in part off the activity. Removing any sort of
barrier to physical activity which may have unsuitable programs for people with Down
Syndrome. Implementing some of these findings into sessions and training with people with
Down Syndrome may have a positive effect on more physical education and a healthier more
active lifestyle.

As mentioned in the Australian Physical Activity and Sedentary Behaviour or 24-Hour

Movement Guidelines, people with down syndrome should look to achieve the exercise
requirements within their age group.
This would include a variation of the following movements
 Moderate to an intense set of aerobic activities, such as walking, swimming, cycling,
boxing, dancing and rowing

 Some examples of light physical activities, may include something as simple such as
housework, gardening, or light aerobic exercises
  Exercise’s involving muscle and bone strengthening exercises are vital which may
include something enjoyable and interactive such as resistance training with bands,
medicine balls, body weight or dumbbells.

On upon seeing an exercise physiologist, they might suggest to also prescribe specific
exercises to address functional goals for a specific person depending on severity of the
person with Down Syndrome, such as balance training to improve the stability or
functional lower limb strength and certain types of endurance training to improve overall
gait speed and a walking endurance which can be great in terms of more enjoyment out of
life on leisure activities
Exercises can be done individually but I would always recommend having in in a group
setting to promote socialisation and motivation, I know this is something we spoke about
as a strong trait already but it will encourage the person to keep doing the exercise if it
means interpersonal skills are required. An exercise physiologist will always tailor a
program to suit the specific persons goals, the important thing is to modify if not working
and to track the progress and learn from mistakes and new experiences.

“Individuals with DS have a lower exercise capacity, which is thought to be linked to abnormal
catecholamine response and a sympathovagal imbalance. Exercise has been found to improve
sympathovagal imbalance as well as improve heart rate recovery and reduce oxidative damage in
individuals with DS” (Green, 2015). Conducting the output of a person with Down Syndrome is
hugely important as too much or too little can have a knock on effect but the following of these
recommendations can be a likely outcome for a healthier person with DS.

“The Physical Activity Guidelines for Americans (2008) recommends at least 150 minutes of
moderate intensity aerobic activity should be completed each week, if the individual is able. If
they perform vigorous intensity aerobic activity, only 75 minutes are needed per week. If
desired, a combination of the moderate and vigorous intensities can be performed. These should
be done in bouts of at least 10 minutes spread throughout the day to gain the maximum benefit”
(Spurgeon, 2014).

Alongside the evidence of above information and what ive already provided

It “shows that exercise training can help ease the difficulties that individuals with DS experience
when exercising and thus increase the chance that they will participate in physical activity which
would have multiple positive influences on their health, including a reduction in risk of serious
chronic diseases such as heart disease and cancer” (Spurgeon, 2014).

To sum here, an another example of the ACSM recommends a daily expenditure of at least
200KCAL. Although some research, it is important to note that future investigations are
definitely needed to identify the optimal volume and intensity of exercise and workouts
associated with benefits in people with Down Syndrome. The investment of this research has the
potential to enhance a person’s life with Down Syndrome which I think fair to say has received
minimal attention in recent years
Limitations

Along with the good and accessibility of physical education for people with Down Syndrome
often it is not as simple as this, with a number of limitations coming into effect when coaching or
setting up exercise’s and workshops for people with Down Syndrome. A study taken already
mentioned in this report found that “All the mothers cited their children’s health and medical
issues as the most significant barrier to them engaging in physical activity. Several participants
noted that health problems (e.g., obesity, osteoporosis, and heart problems) prevent children with
DS from exercising. One mother described her son’s problems; he has “weakness of his muscles,
health problems, such as heart, leg, and knee problems and osteoporosis.” Another stated,
“Sometimes obesity may be the reason that the movement is heavy.”(Alghamdi, 2021)

Another commonly seen issue and limitation was that of sheer boredom. It seemed that often
children with Down Syndrome became very bored easily when exercising, dancing, or even
playing with toys at a younger age. One mother in the study mentioned said her daughter is often
“feeling bored when you play a game with her, she plays once alone, and she gets angry and
screams when I tell her to build blocks.”

Another limitation alongside this being that the participants noted that the process of aging in
people with Down Syndrome limited their physical activity. This finding goes in unison with the
fact of other studies showing that children with Down Syndrome became less active as they get
older (Barr & Shields, 2011 and McGarty & Melville, 2018).

The subsequent decrease in the level of physical activity in people with Down Syndrome may be
due to increased body weight and musculoskeletal problems as they get older. Although physical
activities are hugely important for children of all ages sadly mothers in the current study reported
that their children had limited engagement in school physical activities due to these very reasons.

However, what methods can we use to tackle these issues and limitations.

1.

Regular engagement and monitoring for children with Down Syndrome as they get older, is
crucial to maintain their fitness and muscle strength. This information can be passed on to health
physician’s, carers etc and is vital information.

2. Engaging Sessions, make sure each session is different, exciting and engaging. Prevent the
opportunity of boredom, don’t keep the same exercise for too long.
3. Learn from Mistakes, keep trying new things. The only way to find out if people enjoy
something is by trying it. Look for reactions and if they are positive continue with them.

4. Adapt, often sessions may have children with DS in them alongside ones who don’t, adapt you
sessions to suit everyone. This will come through planning and trial and error

5. Listen, Ask questions on what interests the people with Down Syndrome, if they enjoy e.g
swimming, if possible do a session in the pool and adapt for everyone depending on numbers etc.
The idea is to give the person/persons with DS their required exercise but also promoting Fun,
social skills, life skills.

Conclusion

In Conclusion certain Individuals with Down Syndrome are physically inactive, along with a
large amount of non-down syndrome individuals, the result in sedentary lifestyle is associated
with multiple health consequences and a jump in healthcare costs. An average cost of $4,287 is
spent every year on healthcare in the United States for every individual with Down Syndrome,

Diabetes and heart disease are the two of the top costs with an estimate of around 250,000
individuals having Down Syndrome average costs in the US could surpass $1,071,750,000.
However as discussed, this is a preventable risk factor, by following the 8 key components
mentioned in the introduction a sedentary lifestyle can cease to exist and thus decrease the
contribution to disease development and quality of life.

In summary to the limitations it may sound as easy as just showing up for a person with Down
syndrome to participate in physical activity as it does for those without the disability, but it really
is not. There are several barriers some already mentioned by issues such as obesity and diabetes,
have a huge impact on whether it is even safe at all to participate in physical activity. Since a
large number of these individuals with Down syndrome are overweight. They are often used to
living a sedentary lifestyles, and changing these normal behaviours can take a large amount of
effort, as is common with most sedentary, obese individuals. “Muscle hypotonicity is a problem
for younger individuals with Down syndrome. This usually gets better as the person gets older,
but muscle-strengthening exercises can help as well. This does, however, limit what can be done
weight-wise.” (Spurgeon, 2014)

To add further the individual must be also very careful not to overstretch any of their muscles,
which is what can happen as a result of hypotonicity, this can result from trying to lift too much
weight too soon. Another issue seen may be Joint hypermobility and is a common problem in
Down syndrome. This increases the risk of dislocating a joint, such as a shoulder or hip, so a
physician should be consulted before beginning any exercise to determine the safety of the
proposed activity program as already mentioned as Step 1 in the introduction.

A promising and good solution to the promotion of people with Down Syndrome was by the
University of Tennessee establishing something called the “FUTURE” program. “This is a two-
year program for students ages 18-29 with intellectual disabilities and autism, and many of the
participants have Down syndrome. This program allows these individuals to take on-campus
courses that teach them social skills and how to live independently. They also participate in
physical education classes as part of the program. After completing the program, students receive
a University of Tennessee FUTURE Post-Secondary Educational Certificate” (Spurgeon, 2014)

To finish we have covered

1. Consulate with doctors/ physicians - along the way and journey to contribute to a healthy
life. This includes diet which we didn’t really have time to cover
2. Cardiovascular exercise importance - running, skipping hopping. Promotes weight loss.
3. Strength training - Increases durability and longevity in muscles, bones, mental health.
4. Flexibility and Mobility – strengthens key muscle joints
5. Balance and Cooridation – Important motor skills and also enjoyable fundamental
movement skills to incorporate in sessions
6. Fun – Ensure everyone is enjoying themselves, if they are having fun they will come
back and keep this healthy and happy lifestyle
7. Safety – Ensure you are well prepared and have suitable sessions set up for students.
Have emergency numbers saved and be alert and ready.
8. Indivindisualsed Approach- set your sessions for the person not for the so called
Disability, if its personal its more likely to stick with the person

References

Silverman, W., 2007. Down syndrome: cognitive phenotype. Mental retardation and
developmental disabilities research reviews, 13(3), pp.228-236.

Kerstiens, R.L. and Green, M., 2015. Exercise in individuals with Down syndrome: A brief
review. International Journal of Exercise Science, 8(2), p.10.

Dodd, K.J. and Shields, N., 2005. A systematic review of the outcomes of cardiovascular
exercise programs for people with Down syndrome. Archives of physical medicine and
rehabilitation, 86(10), pp.2051-2058.

Pitetti, K., Baynard, T. and Agiovlasitis, S., 2013. Children and adolescents with Down
syndrome, physical fitness and physical activity. Journal of Sport and Health Science, 2(1),
pp.47-57.

Hardee, J.P. and Fetters, L., 2017. The effect of exercise intervention on daily life activities and
social participation in individuals with Down syndrome: A systematic review. Research in
developmental disabilities, 62, pp.81-103.
Spurgeon, C.B., 2014. Physical activity in individuals with Down Syndrome.

Alghamdi, S., Banakhar, M., Badr, H. and Alsulami, S., 2021. Physical activity among children
with down syndrome: maternal perception. International journal of qualitative studies on health
and well-being, 16(1), p.1932701.