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On June 29th, I finished the first group of Down with Fitness classes. These are fitness classes geared towards children with Down Syndrome. These classes have been running for five Saturdays in a row, for about an hour, at the gymnasium at St. Gabriel’s Catholic Church in McKinney, TX.

We’ve had anywhere between three and eight kids at each of these, ranging in age from three years old all the way to nine years old. Each class also included parents and siblings to help and to participate along with their kids. The idea behind the class is to get the kids moving, work on motor skills and basic fitness, and show the parents that creative and fun fitness activity is possible with their kids (and that their kids would enjoy it).

Each of these classes was organized in a similar manner, though things have been progressively becoming more challenging for the kids. We begin each class with mobility exercises, though we’re not calling them that. In the pictures you see us walking like T-Rex’s and walking like little kitty cats.

Walking like a T-Rex

Walking like a T-Rex

Walking like  cats Walking like cats[/caption]After that, we hop like kangaroos, frogs, or bunny rabbits and then play a fast game of tag.tag

tag2</aThis all serves as a great warm up and gives the kids a chance to develop their muscles as well.

After the mobility exercises we progress to hula hoops. A large number of exercises are done with the hula hoops. These include stepping in and out of the hoops (and the hoops are held at different heights to make this more challenging), putting the hoops around a body part (put them around your arm, leg, etc.), and lifting the hoops to certain heights (lift it overhead, lift it to your shoulders, etc.). hopping

walking through the hoops

walking through the hoops

around the waist

around the waist

lift the hoops

lift the hoops

After those exercises, the hoops are put on the ground to make an obstacle course. First the kids would walk through them, then hop through them, then the hoops would be spread out to make the exercises more difficult. After that, mini-hurdles are used for zig sagging around and for walking over. Finally, the kids throw bean bags into the hoops.hurdles1

zig zags

zig zags

The next activity involves tunnels, kids love crawling through tunnels. After the kids have crawled through the tunnels for awhile, the ball is introduced and the kids push/throw the ball through the tunnel as they crawl through.tunnels

Finally, some type of ball-related activities are introduced. During these classes we have used basketballs, footballs, Frisbees, soccerballs, and on this session we’re using little hockey sticks to hit balls into goals. hockey1

hockey2 After all of that, the session ends with some free play to help the kids wind down.

I wasn’t sure what offering this class would be like, but it has been a lot of fun and very rewarding. I’m going to start this up again in August, run it four 4-5 weeks, take a break due to little kids’ baseball, then start up again in November.

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Individuals with Down Syndrome, especially as they age, tend to be characterized with obesity, health-related problems from that obesity, poor fitness, a reduced physical work capacity, as well as hyperflexibility and low muscle tone.  In the latest issue of Exercise and Sport Sciences Reviews, Fernhall et al discuss the cardio-vascular impacts of Down Syndrome and the impact of exercise training on this.

 

The authors begin by discussing the low work capacity (i.e. maximal oxygen consumption) of individuals with Down Syndrome (DS):

·      Individuals in their 20’s with DS have a maximal oxygen consumption equivalent to a 60-year old without DS.

·      Maximal heart rates in people with DS are typically 25-30 beats/minute below that of people without DS.

 

What causes these?  The authors note that this is not due to congenital heart disease due to the fact that the studies examining this exclude people with congenital heart disease.  Traditionally this has been thought to be due to a lack of understanding/comprehension and a lack of motivation on the part of people with DS.  However, the authors report that with training individuals with DS can take a maximal oxygen test on a treadmill and produce consistent results, so understanding and motivation are not issues. 

 

Other possibilities are a lack of physical activity or obesity.  Interestingly, the authors report that while the DS population is sedentary it is not more so than the general population.  Based upon the authors’ research, 8-10 hours of week of training still result in unusually low work capacities.

 

In the non-DS population, as we age we tend to accumulate more body mass.  As this happens our work capacity declines.  In the DS population, as they age they also accumulate more body mass but their work capacity remains constant.  According to the authors, maximal oxygen consumption remains in the mid twenties (ml/kg/min) for people with DS between the ages of 9 and 45; whereas for the non-disabled population (on average) it changes from about 45 ml/kg/min to about 35 ml/kg/min over that same age range. 

 

All of this combined suggests that understanding, motivation, obesity, and activity level are not the culprits of the reduced work capacity seen in individuals with DS.  While this is oversimplifying the discussion somewhat, essentially the authors report that a combination of the brain’s control over heart rate and a reduced production of catecholamines (for example, epinephrine) are the likely culprits behind this reduced work capacity.    In other words, due to the brain’s regulation a person with DS has a lower heart rate, which has an impact over their ability to supply oxygen to their body, which reduces their ability to perform long, strenuous exercise.

 

The authors report that exercise helps with this.  I wrote an article a number of years ago about exercise and Down Syndrome, and at the time (and even today) there was little research on this.  The good news is that exercise helps individuals with DS just like it helps individuals without DS.  The challenge is that parents, siblings, caregivers, and individuals working with someone with DS need to be cognizant of these limitations because they impact motivation and require creative ways to address the fitness of a person with DS. 

 

Fernhall, B., Mendonca, G.V., and Baynard, T.  (2013).  Reduced work capacity in individuals with Down Syndrome: A consequence of autonomic dysfunction?  Exercise and Sport Sciences Reviews, 41(3), 138-147.

 

 

I’ll be conducting a fitness program for children with Down Syndrome beginning in June.  It’s going to run on Saturdays from 2 until 3 at St. Gabriel’s Catholic Church in McKinney, TX.  St. Gabriel’s is graciously letting me use their gymnasium for this program.  Thanks to their generosity, this program is being offered at no charge to families of children with Down Syndrome.

I have several goals with this program.  First, to get these kids moving and active.  I don’t think kids in general respond well to structured exercise programs (for example, do three sets of ten crunches) so we’ll be approaching this through movement activities and games that they should find fun.  Second, I’d like to convince family members that their kids can enjoy movement and that it is not difficult to incorporate this into their lives.  Finally, it’s a great opportunity to socialize everyone and get past some of the scare factor that can be associated with working with special needs individuals.

The program information, along with a registration flier, can be found at: program information

In February the Texas Comptroller released a report entitled “Gaining Costs, Losing Time: The Obesity Crisis in Texas.” The report can be found at: http://www.window.state.tx.us/specialrpt/obesitycost/ . It’s an important document because it provides a great deal of statistical and financial information for lawmakers in Texas.

First the big-picture statistics. According to the Comptroller’s report:
• Two thirds of Texas adults are overweight or obese.
• Almost 30% of Texas adults are obese.
• Both these are higher than the national averages, though not by much.
• More than 20% of Texas children aged 10-17 are obese (not overweight, they are obese), which is higher than the national average.
• Obese individuals spend $1429 per year on health care, which is 41.5% higher than normal-weight persons.
• In Texas, the Comptroller reports that obesity cost Texas businesses $9.5 billion in 2009.

Drilling down into the statistics, the information isn’t surprising but it bears repeating (keep in mind, these numbers are for Texans):
• Older individuals are more likely to be obese.
• Black and Hispanic adults are more likely to be obese. Child obesity is also more common among these populations.
• Education and income impact obesity:
o 22.2% of college graduates were obese vs. 37.4% of individuals without a high school diploma
o 38.1% of Texans earning $15,000-24,999 annually were obese vs. 26.3% of individuals earning more than $50,000 per year
• Obesity directly cost insurance companies (in Texas) $4 billion in 2009. This translates into increased insurance premiums and co-pays for everyone.
• The fitness level of Texas children is terrible. Using the Fitnessgram test results, the following is the percentage of students (by grade) who tested in the healthy fitness zone in 2009-2010:
o 3rd grade: 37.3% of girls, 31% of boys
o 4th grade: 34.2% of girls, 25.3% of boys
o 5th grade: 30.1% of girls, 21.8% of boys
o 12th grade: 8.1% of girls, 8.5% of boys
o Notice a trend as children get older?

So there is a problem. More Texans are obese or overweight, this leads to rising health care costs, disease, early death, and rising insurance costs. The Comptroller’s report has a number of recommendations.

A lot of these are things that should be done, but they won’t help (printing the number of calories in restaurants, education, etc.). I don’t say this to be negative, but the fact is that people understand how they should eat – they just chose not to eat that way.

The recommendations that I like from the report are:
• Study the link between fitness and academic performance. If there is one, this allows one to build a powerful case on why this is important. Performance on the TAKS test means money and prestige to school districts, if one can make the case that improving fitness would improve results…
• Restore the high school PE graduation requirement to 1.5 credits.
• Increase middle-school PE requirements to six semesters.
• The last two bullets at least provide the opportunity to make physical activity a habit and provide some physical activity to Texas’ children.