Low physical fitness levels in older adults with ID: Results of the HA-ID study

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Abstract

Physical fitness is as important to aging adults with ID as in the general population, but to date, the physical fitness levels of this group are unknown. Comfortable walking speed, muscle strength (grip strength), muscle endurance (30 s Chair stand) and cardiorespiratory endurance (10 m incremental shuttle walking test) were tested in a sample of 1050 older adults with ID, and results were compared with reference values from the general population. Across all age ranges, approximately two-third of the entire study population scored ‘below average’ or ‘impaired’. Even the youngest age groups (50–59 or 50–54 years) in this sample achieve similar or worse results than age groups 20–30 years older in the general population. Low physical fitness levels in older adults with ID demonstrate that this group is prone to unnecessary premature loss of functioning and health problems, and maintaining physical fitness should have priority in practice and policy.

Highlights

► Two-third of older adults with ID have ‘below average’ fitness levels. ► Seniors with ID in their 50 s are similarly unfit as other seniors in their 70 s. ► Physical fitness training needs to become part of daily care for older adults with ID.

Introduction

In old age, physical fitness plays a vital role in health and independence (WHO, 2009, WHO, 2010). Low fitness is a risk factor for cardiovascular disease and musculoskeletal health conditions, such as osteoporosis and loss of muscle mass, and increases the risk of falls (Mazzeo and Tanaka, 2001, DHHS, 2008). Low physical fitness is preventable or reversible by physical activity and structured exercise (Chodzko-Zajko et al., 2009), which opens up possibilities to maintain or positively influence health and independence into old age. The aging population with intellectual disabilities (ID) is rapidly increasing, due to longer life expectancy as a result of improved healthcare on the one hand, and an increase in absolute numbers of the total population on the other (Patja, Iivanainen, Vesala, Oksanen, & Ruoppila, 2000). Childhood mobility impairments, lifelong low physical activity levels (Hilgenkamp et al., 2012a, Temple et al., 2006), as well as multiple chronic health conditions (van Schrojenstein Lantman-De Valk, Metsemakers, Haveman, & Crebolder, 2000), that increase with age, may pose risks for low physical fitness in this group. Indeed, lower fitness than in the general population has already been demonstrated for younger adults with ID (Carmeli et al., 2002, Fernhall, 1993, Graham and Reid, 2000, Lahtinen et al., 2007). Prevention and intervention of low fitness is of paramount importance to maintain skills for Activities of Daily Living (ADL), health and well-being, and prevent increase of care dependency and care costs (Bartlo and Klein, 2011, Calders et al., 2011, Heller et al., 2011). To determine the priority of fitness programmes for health policies in older adults with ID, it is necessary to investigate the nature and scale of the problem of low physical fitness in this population.

Research in younger adults with ID has identified some components of physical fitness as major indicators for overall fitness, such as cardiovascular capacity, muscular strength and endurance, and obesity (Fernhall, 1993, Pitetti et al., 1993). These components have been found to be important not only in daily functioning, but are related to future health outcomes in the general population (DHHS, 2008). In addition, comfortable walking speed yields very promising results in predicting adverse outcomes in the general population (Abellan van Kan et al., 2009, Cooper et al., 2010, Cooper et al., 2011). Since obesity is not included in the performance-related description of physical fitness in older adults with ID discussed earlier (Hilgenkamp, van Wijck, & Evenhuis, 2010), this study will focus on cardiovascular capacity, muscle strength, muscle endurance and comfortable walking speed. The question of this paper is: What is the level of physical fitness of older adults with ID?

Section snippets

Study design and participants

This study was part of the large-scale Dutch cross-sectional study ‘Healthy ageing and intellectual disabilities’ (HA-ID), executed by a Dutch consort of three ID care services (Abrona at Huis ter Heide; Amarant at Tilburg; and Ipse de Bruggen at Zwammerdam), in collaboration with two university institutes (Intellectual Disability Medicine, Erasmus Medical Center at Rotterdam; and the Center for Human Movement Sciences, University Medical Center at Groningen). All 2150 clients with intellectual

Results

Descriptives of participants of HA-ID and of participants of the four fitness tests are provided in Table 3. The largest subgroups are: age 50–59 years, moderate ID, other etiologies than Down syndrome and being able to walk independently. Generally, adults with severe or profound ID and adults in a wheelchair could participate only moderately in the fitness tests and will therefore be underrepresented in the results; adults in the age category 50–59 were overrepresented, as were adults with

Discussion

This first study of physical fitness in older adults with ID, applying instruments that have been evaluated thoroughly in the general population, shows that physical fitness levels in this group are much lower than in the general older population. Across the tests addressing walking speed, grip strength, muscular endurance and cardiorespiratory endurance, percentages of participants scoring below the lower limits of average ranges in the general population, are astonishingly high. Across all

Conflict of interest

The authors declare that there are no conflicts of interest.

Acknowledgement

This study was carried out with the financial support of the ZonMw (grant nr. 57000003), with no involvement in recruitment, data collection, analyses and interpretation of data, in writing the article or in submission for publication.

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