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

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