1. Clinical Bottom Line: We suggest an exercise program that includes both aerobic and strength training for our patient with Down syndrome (DS). Although the clinically significant effects of exercise on measures of health and function appear minimal in the available research, there was a trend towards improvement with cardiorespiratory, strength, and function variables in most of the studies we reviewed. The only outcomes that did not display significant changes in any of our studies were the anthropometric variables. It appears that the true effects of exercise are hidden by poor study design and failure to thoroughly report study methodology and raw data. Of all the categories of outcome measures we analyzed, strength improvements appear to have the largest effects at this time. We feel it is appropriate to suggest an aerobic and strength training regimen for our patient because no adverse outcomes were reported, the intervention is low cost, and because exercise promotion for this population is consistent with national objectives defined in Healthy People 2010. More high quality research needs to be done to identify which specific exercise programs are most effective in addressing measures of general health and function and how large the effects are.
2. Clinical Scenario: A 12-year old male diagnosed with DS is being seen at our clinic. His mother is concerned about the sedentary lifestyle of her child considering the national epidemic of obesity of individuals with disabilities and the United States population at large. She is aware there is an especially high prevalence of heart problems and shortened life-span for individuals with DS. She would like to know if strengthening and aerobic conditioning, as a preventive measure, would improve her son’s general health and function both now and into adulthood.
3. Our clinically answerable question: Population: Children and adults diagnosed with DS. Intervention: Exercise programs consisting of aerobic and/or strength training. Comparison: Control groups who receive no treatment. Outcome: Cardiorespiratory measures including maximal oxygen consumption (VO2 max), heart rate (HR), respiratory exchange ratio (RER) and minute ventilation (VE); measures of functional tolerance to activity such as workload, resistance/grade, speed, time and distance; body composition measures including body weight, body mass index (BMI) and skin fold; and strength as measured by exercise resistance and repetitions, one repetition max (1 RM), and dynamometry.
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