Measuring physical fitness in Persons with Severe/Profound ...

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Exclusion criteria were mental or physical health problems that prevented the client fromparticipating. A physician, specialised in the care for people with ID, approved participation.Exclusion criteria at the moment of testing were illness or fever, recent epileptic insult, stress,wound, concussion or pain during movement.DesignParticipants were tested twice, the first graded treadmill test (GXT1) was followed by a secondgraded treadmill test (GXT2) at least one week later. Both tests lasted 15-25 minutes. The sameinstructor and the same test leader performed the testing procedure at the same time of day.The test leader scored HR peak, attained level and test time.A two-minute supra-maximal block test (SMBT) followed at random either GXT1 or GXT2(convenience sampling). A Trimline T370HR treadmill (Tunturi, Almere, the Netherlands) wasused for testing. A Polar RS 800 heart rate monitor (Polar Nederland, Almere, the Netherlands)measured heart rate during the test.Ethical statementThe study was performed in agreement with the guidelines of the Helsinki Declaration as revisedin 1975. Permission to carry out the study was obtained from an institutional ethics committee. Allparticipants were unable to give consent. Therefore extra care and attention was given to:1) Obtaining informed consent. Informed consent was obtained from legal representatives andcaregivers of all participants;2) The construction of the study group by formulating exclusion criteria and contraindications:We screened the participants based on the examination findings of a physician specialised inintellectual disabilities and also of a behaviour scholar;3) The measurement procedure: The measurements were performed in accordance with thebehavioral code section entitled ‘Resistance among people with an intellectual disability in theframework of the Act Governing Medical-Scientific Research Involving Humans’ [20]. Consistentdistress or unhappiness was interpreted as a sign of lack of assent and further participation in thestudy was reconsidered.ProtocolsGraded treadmill test (GXT)The adjusted SRT protocol of Waninge et al. was used and performed on a treadmill [12]. Allparticipants practiced walking the treadmill at least twice before being tested. The speciallytrained physical education instructor (instructor) accompanied the participant to the treadmilland attached the safety cord. The instructor explained the procedure and attached the belt of theheart rate monitor to the participant. To ensure safety the instructor positioned himself behindthe participant, with a foot on each side of the treadmill. The test leader checked the heart ratemonitor and stayed one meter on the side of the participant during the whole test procedure.Rintala et al. reviewed the familiarization process in cardio-respiratory fitness testing inpersons with mild to moderate intellectual disabilities, recommending a familiarization protocol[21]. To reduce stress due to unfamiliar situations, the participants walked the treadmill at leasttwice at regular walking speed before testing. Participants did not reach their HR peaklevels duringthese practice sessions.Chapter 5 | 73
The treadmill stood in a gymnasium where other clients were doing workouts. The testleader calibrated the treadmill once a week to guarantee reliability. The starting speed was 3 km/hour for all participants. Each minute the speed increased with alternating 0.3 and 0.2 km/hourincrements to reach the next level. Levels were comparable with the levels in the Waninge study[12], in which 0.5 km/h increase of speed appeared not feasible for persons with SIMD.The test continued until volitional exhaustion, similarly to the study of Rintala et al [16].The test was finished in three possible ways; when the participant insisted he wanted to stopor refused to continue, when the predicted HR peak[13] was reached, or when the safety pin waspulled. The level maintained during the last full minute stage counted as the highest attainedlevel. After either GXT1 or GXT2, the participant rested for five minutes and went on to performthe SMBT.Seven instructors participated in data collection. Two physical therapists acted as test leaders.They checked exclusion criteria at the moment of testing on a form filled out by the participant’spersonal care professional.Supra Maximal Block Test (SMBT)The individual gold standard for HR peakwas set by SMBT [19]. Midgley et al [19] reported theutility of the verification phase, which was performed at a speed equivalent to one stage higherthan that attained during the last completed stage of the incremental phase. They did notexactly define the incremental phases and corresponding speed, as they found that ‘despite theincremental phases being distinctly different, the mean maximal VO2max values attained in theappended verification phases were almost identical’ [19]. Therefore, in the present study, speedduring the verification phase was 0.2 or 0.3 km/h higher than speed during the last completedstage, as in persons with SIMD only an increase of speed of 0.2 or 0.3 km/h is feasible [12].This is considered an acceptable increase of speed, because Midgley et al [19] stated that ‘theverification phase should incorporate a workload higher than that attained in the incrementalphase to conform to the original concept of VO2max’. If the heart rate of the SMBT differed bynot more than two beats from the HR peakreached during the corresponding GXT, the performanceduring the GXT was scored as maximal [19]. During the two minutes of the verification phase, theattained HRpeak was registered in beats per minute.Two alternative protocols were developed. Criterion A was the SMBT [19]. The participant walkedfor another two minutes at a level one step (0.2 or 0.3 km/hr) higher than the level attainedduring the GXT. If the instructor thought, for instance for behavioural reasons, an increase in levelwas not feasible, the participant performed criterion B, which was a two minutes maximal blocktest at the highest previously attained level. The HR peakwas registered in beats per minute. Validitycalculation did not include results from criterion B.MotivationSince people with ID tend to have lower motivation for physical activity, motivation wasconsidered as a factor influencing the validity of the test [3, 16]. Paired modelling and positivereinforcement have a positive effect on compliance to treadmill walking for people with moderateto severe ID [22]. Participants were encouraged to continue walking using these techniques. Boththe instructor and the test leader observed independently the amount of encouragement givenas well as the compliance with the task. The observed motivation was defined as to how well the74 | Chapter 5
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Measuring physical fitnessin person
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Rijksuniversiteit GroningenMeasurin
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Chapter 1IntroductionChapter 1 | 9
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overweight [15]. This prevalence is
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Theoretical framework of the studyI
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Components of physical fitnessThe a
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Therefore, a study is put forward w
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2002;40:436-444.19 Temple VA, Frey
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Chapter 2Feasibility and reliabilit
Page 24 and 25: IntroductionPhysical fitness and he
Page 26 and 27: GMFCS was presented to the investig
Page 28 and 29: Body weightTo determine the body we
Page 30 and 31: Table 1 Results of Wilcoxon rank te
Page 32 and 33: Calculation of heightThe mean (SD)
Page 34 and 35: DiscussionThe results of our study
Page 36 and 37: References1 Bouchard C, Shepard RJ,
Page 38 and 39: 37 Rimmer J, Kelly LE, Rosentswieg
Page 40 and 41: Chapter 3Measuring waist circumfere
Page 42 and 43: IntroductionChildren and adults wit
Page 44 and 45: participants. These calculations as
Page 46 and 47: Data analysisThe data were analyzed
Page 48: Table 2. Simple regression analysis
Page 54 and 55: Chapter 4Feasibility and reliabilit
Page 56 and 57: IntroductionPeople with intellectua
Page 58 and 59: Eighty representatives gave permiss
Page 60 and 61: 3) The measurement procedure: The m
Page 62 and 63: and whether motivation influenced t
Page 64 and 65: Table 3. Mean peak heart rate achie
Page 66 and 67: AcknowledgementsThis research was f
Page 68 and 69: 21 Hopkins WG, Gaeta H, Thomas AC,
Page 70 and 71: Chapter 5Psychometric quality of a
Page 72 and 73: IntroductionIntellectual disability
Page 76 and 77: participant had fulfilled the task.
Page 78 and 79: Table 2. Descriptive results peak h
Page 80 and 81: Table 3. Test-retest reliability of
Page 82 and 83: Table 4. Correlation scored motivat
Page 84 and 85: preceding GXT results on HR peak. G
Page 86 and 87: References1 Schalock R, Brown I, Br
Page 88 and 89: 37 Stanish HI, Temple VA, Frey GC.
Page 90 and 91: Chapter 6Feasibility and reliabilit
Page 92 and 93: IntroductionLocomotor skills in peo
Page 94 and 95: this study was to evaluate the feas
Page 96 and 97: obtained from the legal representat
Page 98 and 99: Modified Berg Balance Scale scoresI
Page 100 and 101: Modified Berg Balance Scale scoresT
Page 102 and 103: References1 Van Erkelens-Zwets JHJ
Page 104 and 105: 39 Dorai-Raj S. Binomial Confidence
Page 106 and 107: Chapter 7Feasibility, test-retest r
Page 108 and 109: IntroductionPersons with profound i
Page 110 and 111: DesignThe muscle tone and spasticit
Page 112 and 113: Interrater reliabilityFirstly, to d
Page 114 and 115: Table 3. Summary of the statistical
Page 116 and 117: Table 6. Summary of the statistical
Page 118 and 119: RecommendationsThe feasibility of c
Page 120 and 121: 18 Gielen EJJM. Is spasticiteit te
Page 122 and 123: Chapter 8Heart Rate Pattern as an I
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IntroductionIt is important to gain
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48 persons18 persons lacked permiss
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Furthermore, the mean and the range
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Table 3. Day-to-day outline of the
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Relation between heart rate pattern
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patterns in this study we can concl
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References1 Emerson E. Underweight,
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38 Multilevel Models Project (2004)
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Chapter 9General DiscussionChapter
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on this. To sum up, testing in pers
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for future research it is recommend
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studies. Randomized Controlled Tria
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of these individuals require more?
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19 Lahtinen U, Rintala P, Malin A.
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SummarySummary | 151
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problems in both locomotor skills a
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subjects are to be applied to perso
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may be an indicator of activity lev
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SamenvattingSamenvatting | 159
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InleidingVoldoende bewegen en fithe
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verstandelijk niveau en bepaalde mo
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Hieruit bleek, dat de motivatie van
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Verder is duidelijk geworden dat me
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DankwoordDankwoord | 169
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De leden van de leescommissie, prof
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Judith van der Boom, dank je wel vo
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Dankwoord | 175
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Curriculum vitaeCurriculum vitae |
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Curriculum vitae | 179
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