Measuring physical fitness in Persons with Severe/Profound ...
Measuring physical fitness in Persons with Severe/Profound ...
Measuring physical fitness in Persons with Severe/Profound ...
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Yet, no difference was found between these groups. For our target group, <strong>in</strong>clud<strong>in</strong>g thosesuffer<strong>in</strong>g from spasticity, MAS seems the preferred measurement <strong>in</strong>strument. This preferencemay be accounted for by the <strong>in</strong>teraction beween multiple disabilities <strong>in</strong> our study population,which may differ <strong>in</strong> that respect from the study populations those of Mehrholz [34] and Gielen[33].However, the validity of the aforementioned <strong>in</strong>struments for measur<strong>in</strong>g spasticity andmuscle tone is beyond the scope of this study. We recommend the validity of the MAS to beexam<strong>in</strong>ed <strong>in</strong> future studies, <strong>with</strong> a focus on measur<strong>in</strong>g the quality of daily movement rather thanmeasur<strong>in</strong>g spasticity, as the MAS may be more suitable for measur<strong>in</strong>g the first.Physical activityDaily <strong>physical</strong> activity contributes directly to health [35] and is an important factor <strong>in</strong> ma<strong>in</strong>ta<strong>in</strong><strong>in</strong>gand improv<strong>in</strong>g <strong>physical</strong> <strong>fitness</strong>. Monitor<strong>in</strong>g daily <strong>physical</strong> <strong>fitness</strong> <strong>in</strong> persons <strong>with</strong> SPIMD is thus animportant step <strong>in</strong> identify<strong>in</strong>g those at health risks.Our research [chapter 8] has shown that daily <strong>physical</strong> activity can be reliably monitoredthrough measur<strong>in</strong>g heart rate patterns. Yet, further exploration of other <strong>in</strong>fluential factors suchas emotions [36] is still recommended. Time of day and age have considerable <strong>in</strong>fluence on heartrate patterns. However, the analysis of heart rate patterns suggests other, probably more personalfactors to have a significant <strong>in</strong>fluence on heart rate patterns [37] which can be explored <strong>in</strong> futureresearch. F<strong>in</strong>ally, our study shows that based on measur<strong>in</strong>g heart rate patterns, <strong>in</strong>dividuals<strong>with</strong> PIMD do not meet the standards of sufficient activity as proposed by the guidel<strong>in</strong>es of theAmerican College of Sports Medic<strong>in</strong>e [38]. Future research can shed a light on the suitability andvalidity of these guidel<strong>in</strong>es for a population <strong>with</strong> PIMD or SPIMD.Methodological issuesThe first methodological issue we encountered had to do <strong>with</strong> the lack of a golden standard.As validity can only be exam<strong>in</strong>ed aga<strong>in</strong>st a golden standard, it would have been convenient anddesirable for a golden standard to be available for every s<strong>in</strong>gle <strong>in</strong>strument measur<strong>in</strong>g a certa<strong>in</strong>concept. Yet realistically, golden standards for our research population are unfortunately simplynot available. If feasible, we attempted to assess validity, for example by perform<strong>in</strong>g a supramaximal block test on the treadmill.Moreover, often neither standard values nor cut-off scores are available, as was the case for theaSRT nor the mBBS.Another methodological issue is related to statistical power. Due to both the relativelysmall group of persons <strong>with</strong> SPIMD and a number of exclusion criteria, a rather small numberof subjects were able to participate <strong>in</strong> the studies described <strong>in</strong> this thesis. However, despite therelatively small study groups the test-retest reliability of mBBS, walk<strong>in</strong>g tests, bodycompositionmeasurements and the MAS were comparable to those of other and larger target groups. In futureresearch, more care facilities and thus subjects should be <strong>in</strong>cluded and classified on both of levelof ID and locomotor skills. This may improve sample size and thereby power. Then it might bepossible to formulate golden standards, group specific standard values and cut-off scores, <strong>with</strong>which the validity of tests can be exam<strong>in</strong>ed and the testscores can be compared.Despite the fact that only cross-sectional designs are used <strong>in</strong> this research, we will touchupon the problems of heterogeniety <strong>in</strong> samples <strong>with</strong> SPIMD <strong>in</strong> the framework of <strong>in</strong>tervention144 | Chapter 9