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Article

Physical Fitness Variables, General Health, Dementia and Quality of Life in Individuals with Intellectual and Developmental Disabilities: A Cross-Sectional Study

by
Miguel Jacinto
1,2,3,*,
Rui Matos
2,3,
Beatriz Gomes
1,4,
André Caseiro
1,4,
Raul Antunes
2,3,5,
Diogo Monteiro
2,3,6,
José Pedro Ferreira
1,4 and
Maria João Campos
1,4
1
Faculty of Sport Sciences and Physical Education, University of Coimbra, 3040-248 Coimbra, Portugal
2
Life Quality Research Centre (CIEQV), 2040-413 Rio Maior, Portugal
3
ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal
4
Research Center for Sport and Physical Activity (CIDAF), 3040-248 Coimbra, Portugal
5
Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, 2411-901 Leiria, Portugal
6
Portugal Research Center in Sport Sciences, Health Sciences and Human Development (CIDESD), 5001-801 Vila Real, Portugal
*
Author to whom correspondence should be addressed.
Healthcare 2023, 11(19), 2688; https://doi.org/10.3390/healthcare11192688
Submission received: 16 May 2023 / Revised: 3 October 2023 / Accepted: 5 October 2023 / Published: 6 October 2023
(This article belongs to the Special Issue The 10th Anniversary of Healthcare—Quality of Life of Older People with Disability in the Community)
Versions Notes

Abstract

:
The average life expectancy of individuals with intellectual and developmental disabilities (IDDs) is increasing. However, living more years does not mean living better, leading to the need for research on comorbidities associated with the aging process. Associated with this process are the physical characteristics most prevalent in an individual with IDD: low levels of all physical capacities, the accumulation of central fat, hyperglycemia, dyslipidemia, and hypertension, variables considered to be some of the main risk factors of the onset of metabolic and cardiovascular diseases, and variables that can negatively impact quality of life (QoL). Therefore, the aim of this study is to evaluate a sample of 21 institutionalized adults with IDD (42.81 ± 10.99 years old) in terms of their anthropometric characteristics, body composition, general health status, functional capacity, neuromuscular capacity, and dementia/cognitive function, and the possible associations with QoL. All assessments were performed in the laboratory of the Faculty of Sport Sciences and Physical Education—University of Coimbra. Participants, in the present study, have low levels of physical fitness and high metabolic and cardiovascular markets, which need to be improved. On the other hand, functional and neuromuscular ability seems to be associated with QoL (p ≤ 0.05). This study highlights the role of primary and secondary care providers in diagnosis, prevention, and supporting individuals with IDDs to promote QoL.

1. Introduction

Individuals with intellectual and developmental disabilities (IDDs) are characterized by a deficit in intellectual and adaptive functioning in the conceptual, social, and practical domains, and can be identified with mild, moderate, severe and profound degrees of disability developed before the age of 22 [1]. Around 17.79% of Portuguese citizens over the age of five reported having major or total difficulties in performing at least one of the six activities of daily living (seeing/sight, hearing, walking, memory/concentration, bathing/dressing, and understanding/making oneself understood) [2].
The accumulation of central fat, hyperglycemia, dyslipidemia, and hypertension are some of the main risk factors for the onset of metabolic diseases and cardiovascular diseases [3,4], and are considered some of the main causes of death in individuals with IDD. When analyzing the population with disabilities (motor, intellectual, or sensory), the prevalence of these factors triples compared to that in the general population [5,6].
Greater longevity is associated with a higher prevalence of cardiovascular and metabolic diseases and other comorbidities [7]. Between 1996 and 2001, the age of death for individuals with IDD was 45 years old (similar for men and women) [8]. From 2003 to 2012, the average age of death increased to 55 years old [9]. Therefore, there has been an increase in the average life expectancy of this population over the years [10], explaining the greater need to study the effects of intervention strategies that promote health improvement and reduce the impact of comorbidities associated with aging [11]. The most common symptoms of aging in individuals with intellectual disabilities include confusion, difficulty with problem resolution, communication, and socialization. It is important that individuals receive appropriate services (educational support, behavioral intervention, vocational training, family education, government resources, and psychopharmacologic interventions), reducing the risk of adverse health conditions, in order to maintain/promote their independence and quality of life (QoL) as they age [12].
Individuals with IDD face inequalities in access to health care [13,14]. These individuals may have significantly different medical, social, emotional, and educational needs compared to those of individuals without disabilities. Similarly, they may often lack the capacity to perceive, report, or address symptoms of disease, which can delay detection and intervention [15,16]. On the other hand, any of the health problems associated with the premature aging of individuals with IDDs begin around the fifth decade of life [17].
These health problems are also attributed to their sedentary lifestyle, and physical inactivity, which are associated with various factors such as a possible lack of motivation, barriers to physical activity, and an unhealthy diet [18,19]. These factors are associated with low physical fitness and health problems such as osteoporosis, musculoskeletal disorders, dementia, and metabolic and cardiovascular disease [20,21]. Similarly to the case for a population without disabilities, a sedentary lifestyle [22], physical inactivity [23], and a higher incidence of obesity [6,24] lead to a major decrease in physical fitness [25,26]. In addition, sedentary lifestyles and low adherence to physical activity also lead these individuals to have low levels of physical abilities.
Considering that the population with IDDs can present all the aforementioned comorbidities and, therefore, negatively influence the activities of daily living and QoL [27,28,29], constant monitoring and the definition of strategies that can promote these variables have become urgent.
Schalock et al. [30] refers to QoL as a set of factors that address an individual’s well-being or the perception of their social position, in the context and culture in which they are positioned, comprising sociocultural values, needs, expectations, and individual preferences. It is a multidimensional phenomenon composed of factors and domains, influenced by personal characteristics and environmental contexts.
Primary and secondary care agents should be able to diagnose, treat, and support individuals with IDD in the promotion of QoL. Identifying individuals with risk factors and developing specific interventions is urgent. It is hoped that early detection and the appropriate treatment/promotion of problems by primary and secondary care agents will help individuals with IDD to maximize their potential and integration into society and promote their QoL.
Therefore, the aims of our study are to describe and characterize participants with IDD (and to understand if there are differences between them and between sexes) in the following parameters: anthropometric characteristics, body composition, general health status, functional capacity, neuromuscular capacity, and dementia/cognitive function. This evaluation will allow us to perform an initial analysis of the participants and identify some types of disease [31]. The secondary objective is to analyze the influence of these variables on the QoL of individuals with IDD. It is important to study the association of these variables with their QoL, for the development of effective strategies to promote these variables.

2. Materials and Methods

The study was approved by the ethics committee (after the submission of the protocol and expert evaluation) of the University of Coimbra, Faculty of Sport Sciences and Physical Education, under the code CE/FCDEF-UC/00872021, and was carried out in accordance with the Declaration of Helsinki for human studies [32]. It is an original part of a previously published study [33]. Participants/family members/guardians signed an informed consent form.

2.1. Participants

The participants included 21 individuals with IDD (23 to 58 years; 42.81 ± 10.99 years old), comprising 11 males (52%; 42.18 ± 10.15 years old) and 10 females (48%; 43.5 ± 12.376 years old). All individuals are institutionalized in a support institution, located in Leiria (Portugal) and are diagnosed with IDD (mild to severe).
The ensuing inclusion requirements were established: (1) age over 18; (2) mild, moderate, or severe IDD (including Down syndrome); (3) the ability to carry out movements, particularly pulling and/or pushing; (4) success in performing the assessments. The exclusion criteria included the following: (1) contraindications to exercise (e.g., high blood pressure); (2) other associated pathologies; (3) an inability to walk unaided; (4) profound IDD; (5) an inability to communicate; (6) a lack of informed consent.

2.2. Procedure

All assessments were carried out in the morning period, in the laboratory of the Faculty of Sport Sciences and Physical Education, University of Coimbra, by the same researchers, to reduce potential measurement errors. The data collected from all the evaluations were transcribed into a specific record form, ensuring that all ethical procedures were followed. To ensure the participants’ safety and comfort, all pre-test instructions were given. The procedures used in the present study are described in more detail in a previously published protocol [33].

2.2.1. Anthropometric and Body Composition Assessment

Weight and height were determined using a scale and stadiometer (SECA 870, Hamburg, Germany). Participants were asked to wear light clothing, wear no shoes, and stand in the Frankfurt horizontal position. The standard formula for calculating body mass index (BMI) was used (BMI = body mass (kg)/height (m)2). Participants were divided into four categories based on the World Health Organization (WHO) classification: “underweight”, “normal weight”, “overweight”, and “obesity” [34]. Then, a body composition assessment was conducted with a tetrapolar multifrequency InBody 770 (Seoul, Republic of Korea) instrument following the manufacturer’s instructions and comprehensive guidelines described [35]. The following variables were assessed: BMI, waist circumference, total body water (L), proteins (kg), minerals (kg), fat mass (kg), muscle mass (kg), lean mass right and left arm (kg), lean trunk mass (kg), lean mass right and left leg (kg), fat right and left arm (kg), trunk fat (kg), fat right and left leg (kg) intracellular water (L), extracellular water (L), and phase angle. For anthropometric and body composition assessments, participants were encouraged not to drink caffeine or alcohol within 12 h prior to the assessments.

2.2.2. General Health Status Assessment

Hemodynamic parameters, such as resting blood pressure (systolic and diastolic) and resting heart rate were measured using a digital sphygmomanometer, Omron Digital Blood Pressure Monitor HEM-907 (Omron Healthcare Europe BV, Matsusaka, Japan). Maximum heart rates were calculated using the standard formulas [31]. Measurements were taken in the morning and participants were instructed to avoid caffeine, exercise, and smoking for at least 30 min before measurements [36].
Heart rate variability (HRV) was also measured in accordance with the protocols of Proietti et al. [37], Task Force of the European Society of Cardiology, and the North American Society of Pacing and Electrophysiology [38], using Polar ProTrainer (Kempele, Finland). The following items were calculated in the time domain: (i) mean RR (the mean of the RR intervals in ms); (ii) SDNN (the standard deviation of RR intervals in ms); (iii) RMSSD (the root mean square of successive RR interval differences in ms); (iv) pNN50 (the percentage of successive RR intervals that differed by more than 50 ms). The following items were calculated, in the frequency domain: (i) LF (the absolute power of the low-frequency band, 0.04–0.15 Hz, in ms2); (ii) HF (the absolute power of the high-frequency band, 0.15–0.4 Hz, in ms2; (iii) the ratio of LF-to-HF power (LF/HF).
Blood samples were collected by accredited professionals using the venipuncture technique [39]. The results of glycemia, total cholesterol and triglycerides were analyzed in the certified laboratory to which the professionals belong.

2.2.3. Functional Capacity Assessment

Functional capacity was assessed using three standardized tests from the Fullerton battery [40], which included the 30 s chair test (the number of executions in 30 s without using the upper limbs; more repetitions means more strength and endurance in the participant’s lower limbs) [41,42]; the timed up and go test (the time that the participant takes to walk 2.4 m, around a cone and sit down again; the less time taken, the greater the speed, agility, and dynamic balance of the participant) [43]; and the 6 min walk test (the distance covered when walking as quickly as possible without running for 6 min; more meters walked means greater aerobic endurance in the participant) [44].

2.2.4. Neuromuscular Capacity Assessment

An isokinetic dynamometer (BIODEX Multijoint System 3 Pro, Shirley, NY, USA), which was suitable for the target population [45], was used to measure lower limb strength via knee flexion and extension, using maximal concentric contractions. Equipment calibration was performed prior to the evaluation session in accordance with the manufacturer’s instructions (Biodex Medical Systems, Inc., 2000, Shirley, NY, USA). Three repetitions of each movement at 60 °/s and 120 °/s were used to test concentric action. A 60 s interval was established between the 3-repetition familiarization and the test, as well as between angular velocities.
A handgrip test, with a manual dynamometer, was used to measure upper limb strength. The reliability and validity of this have been confirmed by Cabeza-Ruiz et al. [43] and Oppewal and Hilgenkamp [46], and the procedures recommended in the Brockport Fitness Test Manual [47] were used. The “3 kg medicine ball throw test” was also applied [48], a protocol valid and reliable for people with IDD [42], in order to assess the muscular strength of their upper limbs.

2.2.5. Dementia/Cognitive Function Assessment

The mini-mental state examination, Portuguese version [48,49], was also used in the present study. The instrument is composed of 30 questions, evaluating the cognitive profile through the assessment of six areas of cognition: orientation, immediate recall, attention, calculation, delayed recall, and language. Its score ranges from 0 to 30 points, and the cut-off values that classify individuals into cognitive profiles are the following: (a) severe cognitive impairment (1 to 9 pts); (b) moderate cognitive impairment (10 to 18 pts); (c) mild cognitive impairment (19 to 24 pts); (d) normal cognitive status (25 pts and above).

2.2.6. Quality of Life Assessment

The Portuguese version of the Personal Outcomes Scale [50,51,52] was applied by technicians with specific training for this purpose. The scale includes eight domains, with 5 questions, resulting in a total of 40 questions, presented with three response options, through the Likert format and answered via self-report. The overall QoL score was used for this study.

2.3. Statistical Analysis

Descriptive statistics were used to characterize the sample, including mean, standard deviation, median, and minimum and maximum. The Shapiro–Wilk and Levene test were used to test the normality of the results. The Kruskal–Wallis H test was used to assess differences between sexes and the Wilcoxon test was used to assess differences between different limbs. The relationship between variables was verified using Spearman’s correlation test, allowing the magnitudes of the associations to be determined (r = 0.10 to 0.29—small; r = 0.30 to 0.49—moderate; r = 0.50 for 1-strong) [53]. All data were analyzed using IBM SPSS Statistics (version 28, IBM Corporation (SPSS Inc., Chicago, IL, USA) and the significance level used was p < 0.05.

3. Results

Demographic data on the characteristics of the participants can be found in Table 1.
Table 2 showed the results of the body composition assessment, performed using the InBody 770 instrument.
Table 2 shows that all 21 participants were in the overweight range. When analyzing according to sex, females were in the obese range and, in turn, males were within the lower threshold of the overweight range [34]. In addition, females had high waist circumference values (p ≤ 0.05) [54].
On the other hand, there were significant differences between sexes in the BMI values (females: 32.6 ± 7.2; males: 25.99 ± 4.95), waist circumference (females: 96.56 ± 13.26; males: 88.56 ± 15.19), total body water (females: 31.58 ± 4.18; males: 35.83 ± 4.97); fat mass (females: 36.64 ± 12.70; males: 20.41 ± 10.42); muscle mass (females: 23.3 ± 3.51; males: 27 ± 4.17); lean mass left leg (females: 6.17 ± 0.94; males: 2.76 ± 0.57); fat right and left arm (respective: females: 3.29 ± 1.77; males: 1.4 ± 0.92; females: 33.46 ± 1.62; males: 1.42 ± 0.91); intracellular water (females: 19.38 ± 2.67; males: 22.33 ± 3.3); and phase angle (females: 5.2 ± 1.33; males: 5.83 ± 0.77).
Then, in Table 3, the results of the health variables are presented.
For all the variables presented in Table 3, there are no differences between sexes. On the other hand, the sample presented high levels of systolic blood pressure and cholesterol.
The results of the three functional tests performed are presented in Table 4.
For the three functional tests performed, there were no differences between sexes (p ≥ 0.05). However, the males showed better values for all variables (mean females ± SD vs. mean males ± SD; 30 s chair test: 12.7 ± 2.58 (s) vs. 14.27 ± 4.81 (s); timed up and go test: 9.43 ± 4.09 (s) vs. 8.27 ± 4.15 (s); 6 min walk test: 460.3 ± 74.76 (m) vs. 486.81 ± 65.66) (m).
The following table (Table 5) presents the results of the evaluation of the neuromuscular capacity, through the knee flexion and extension concentric test, using a isokinetic dynamometer.
There were no significant differences between sexes. However, there were differences between limbs for the extension at 60 °/s (p = 0.019) and at 120 °/s (p = 0.04) tests.
The results of the manual dynamometer and 3 kg throw ball test are presented below, in Table 6.
For the manual dynamometer test, there were differences between sexes in the 3 kg throw ball test (p = 0.035; females: 1.83 ± 0.57; males: 2.67 ± 0.88).
Finally, the results of the mini-mental state examination are presented in Table 7.
No significant differences between sexes were found for all variables (p ≥ 0.05). Considering the values of the test and the corresponding score, the participants presented mild cognitive impairment [48,49]. Similarly, in the sample, there were individuals with severe cognitive impairment [48,49]. No significant differences between sexes were found (p ≥ 0.05).
No significant differences in body composition and general health status variables were found.
In turn, QoL was associated with the functional 30 s chair test (r = 0.441; p = 0.045) and negatively correlated with the timed up and go test (r = −0.596; p = 0.004).
As for the neuromuscular capacity variables, there were some associations, namely between flexion at 60 °/s left (r = 0.549; p = 0.01), flexion at 120 °/s left (r = 0.44; p = 0.046) and manual dynamometer results (r = 0.57; p = 0.007).

4. Discussion

The effects of physical inactivity and a sedentary lifestyle could result in an increased onset of cardiovascular and metabolic disease in adults with IDD [20]. The literature states that, associated with this is the aging process, with higher rates of multimorbidity and frailty at younger ages than in the population without disabilities [55]. Therefore, the aim of this study was to characterize a sample of 21 institutionalized adults with IDD (42.81 ± 10.99 years) at the anthropometric level, and in terms of body composition, physical fitness, general health, and cognitive function, for a subsequent prescription of physical exercise.

4.1. Anthropometric and Body Composition Assessment

The participants of our study were in the overweight range, which increases the probability of having other obesity-related health problems such as type 2 diabetes, hypertension, and obesity-related cardiovascular diseases [6,24]. When we analyzed our participants according to sex, females were in the obese range and, in turn, males were within the lower threshold of the overweight range [34]. In addition, females had high waist circumference values [54].
On the other hand, there were significant differences in sex, BMI values, waist circumference, total body water, fat mass, muscle mass, lean mass left leg, fat right and left arm, intracellular water, and phase angle, with the women showing more unfavorable values, with the causes remaining unclear.
According to the literature, the participants in this study had unfavorable body composition values [56,57]. Future studies should control for variables that may influence these results, such as environmental, institutionalization, behavioral, genetic and/or medical [58] ones, namely eating unhealthy foods, limited access to health care [13,59], and some prescribed medications [60]. Associated with these variables, individuals with IDD are less likely to have opportunities to engage in physical activity (a reason for barriers to practice), which also contributed to these body composition results [18].
The monitoring of the body composition of individuals with IDD, along with the implementation of strategies to promote a healthy lifestyle, namely through physical activity and healthy eating, should be studied. It is also important that this literacy in healthy practices be directed and adapted to both the person with IDD and their support network.

4.2. General Health Status

The results of our study do not indicate elevated blood pressure values. The literature has shown that individuals with IDD have high blood pressure values, even reaching hypertension values. Some prescribed medications for this population, sedentary and inactive lifestyles, poor diets, being overweight, and obesity may explain these results [18,60].
Considering the resting heart rates, the participants in this study were shown to have high values. Communication difficulties (in individuals with IDD who do not communicate, have acute pain, or experience distress, which may be reflected through high resting heart rate values), executive/cognitive functioning, social skills, a lack of physical activity, and physical and mental stress and anxiety may be behind these high resting heart rate values [61,62], as well as autonomic responses to pain and acute distress [63], happiness, excitability [64], or postural changes and muscle work at the time of assessment. Future studies that assess the resting heart rate or that want to promote a decrease in these values, should also look at these mentioned variables.
Another variable that is associated with chronic diseases, namely cardiovascular diseases in individuals with IDD, is HRV. Research has shown that individuals with IDD have a lower HRV than do individuals without IDD [65,66], which is confirmed by most of our results. For example, all participants in this study had SDNN values lower than 50 ms, which are related to a higher risk of cardiovascular diseases [67] and lower QoL [66].
Regarding blood test variables, individuals with IDD may be at a higher risk of developing some type of chronic disease, since they have elevated triglyceride cholesterol and blood glucose values. These values are also higher when compared to those in a population without IDD [68,69].

4.3. Functional Capacity Assessment

There were no differences between sexes in the three functional tests performed; however, in the present study, men presented the best performance for all variables. Most of the literature reports that there are significant differences between sexes in functional capacity, particularly in tests associated with physical capacity, strength, balance, and cardiorespiratory capacity [70,71], indicating that men show more favorable values [72].
Poor functional capacity (due to poor physical fitness, which may be the result of low levels of physical activity practice), along with high rates of being overweight and obesity, increases the risk of developing cardiovascular and metabolic diseases [73,74,75]. In addition, low levels of all physical capacities are predictive of a decline in the performance of activities of daily living, a decline in mobility, and an increased risk of early mortality in adults with IDD [76,77], so the promotion of physical capacity should be taken into consideration in future studies.

4.4. Neuromuscular Assessment

Although there were no significant differences between sexes in the evaluation of peak torque, the literature shows that males tend to show higher levels of strength [71,78], which may be explained by the influence of testosterone [79]. On the other hand, the differences between limbs for the test of concentric extension at 60 °/s (p = 0.019) and at 120 °/s (p = 0.04) may be influenced by the values of females, since no significant differences were found in males. Both sexes showed asymmetries in the peak torque of both lower limbs, although these differences were only significant in females. These asymmetries may be a consequence of laterality, explained by the inequality of the cerebral hemispheres, or they may be related to the dominant limb, leading to biomechanical and postural changes [80,81].
On the other hand, compared to the reference values for the general population (20 to 80 years old), as defined by Neder et al. [82], both sexes in the present study showed lower endurance values, in all tests. In the same sense, comparing our results with those of the study by Raulino et al. [83], namely the initial evaluation carried out, our participants presented lower values in both of the tests performed.
For the manual dynamometer test, there were no significant differences between sexes, contrary to the information found in the literature. Bofosa et al. [84], assessed the explosive, resistant and isometric strength through a horizontal jump, maximum crunches in 30 s, and hand grip strength of individuals with IDD. He found that males presented higher values when compared to those of females. However, and despite the having handgrip strength levels within the normative values for the population with IDD, the females presented relatively low values when compared to the population without disabilities [85]. In turn, despite presenting higher grip strength levels than the females, the males presented grip strength levels below the reference values for the population with IDD and compared to the population without IDD [86].
For individuals with IDD, muscle strength is a differential variable of physical fitness, that is essential in activities, tasks and/or routines of daily living, such as dressing, and personal hygiene, among others [87]. In turn, hand strength is considered a useful indicator of sarcopenia, nutritional status, frailty, and muscle strength [88], so it may be important to introduce this measure in the population with IDD. However, the results of the present study demonstrate that the participants have lower levels of strength. These low levels of strength can be explained by peripheral and central factors, in the activation of motor units and some abnormal intrinsic muscle properties [89,90]. Finally, it is important to monitor muscle strength in adults with IDD, define strategies for decreasing barriers to activity [18], and prescribe adapted exercise to their needs [33,91,92].

4.5. Dementia/Cognitive Function

The participants in the present study have mild cognitive deterioration. In our sample, there were also individuals with severe cognitive deterioration. One potential explanation is a reduced brain reserve (i.e., a smaller brain size, fewer neurons, or a lower synapse count) [93], in the sense that people with IDD may be less resilient to developing symptoms when age is related to neuropathology [94].
On the other hand, studies have shown that dementia is associated with poor physical health outcomes and accounts for 30% of deaths in individuals with IDD [55,95]. Exercise has been associated not only with improved physical fitness, but also with improved cognitive function and a reduced risk of dementia [96,97], as well as increased blood flow in the brain, providing it with essential nutrients and oxygen [98] during exercise, so future studies should consider this relationship.

4.6. Quality of Life

A higher functional and neuromuscular capacity seems to be associated with a higher perceived QoL in our sample. However, more studies with a larger sample size are needed to reach more robust conclusions. In the same vein, future research should analyze this relationship longitudinally.
Since individuals with IDD have sedentary lifestyles and low adherence to physical activity (explained by the existence of barriers to physical activity [18]), strategies to promote QoL may include the prescription of adapted exercise. Although there are barriers to physical exercise practice [18], it is considered a promoter of all physical capacities [99] and, according to the results of our study, may further promote a higher perception of QoL, requiring intervention studies in the study population [33]. In the study by Pérez-Cruzado and Cuesta-Vargas [100], an 8-week physical activity intervention program increased the physical fitness and QoL of 40 individuals with IDD. In the same sense, physical exercise can act as a predictor of improved QoL [101].
Several authors have shown that functional and neuromuscular capacity may affect the QoL of individuals with IDD [29,102], and our results are in accordance with these results. The authors explain these results with the fact that physical fitness is associated with the ability to be independent in the activities of daily living.
The relevance of this kind of research becomes more important when we analyze some preliminary results, such as those of this study.

5. Conclusions

According to our results, in addition to low levels of physical fitness, the sample of our study are at risk of developing metabolic and cardiovascular diseases, highlighting the significance of an intervention with physical exercise, as a way of mitigating and/or delaying some of these associated comorbidities. This initial assessment is important, not only for an initial anamnesis, but also for the development of an adapted, effective and safe prescription of physical exercise programs, according to the participants’ characteristics. On the other hand, the functional and neuromuscular capacity of our sample seems to be associated with a greater perception of QoL. There is a need to raise awareness among people with IDD themselves, parents/families/guardians, professionals who work with them, and institutions/organizations that support this population, educating and empowering them with knowledge and healthy, active practices that will contribute to a healthy life and full social participation. This should be the process to be carried out/approach to be used out before implementing strategies to promote exercise programs and consequently QoL in individuals with IDD, as well as active aging.

Author Contributions

Conceptualization, M.J., R.M., J.P.F. and M.J.C.; methodology, M.J.; software, M.J.; validation, R.M., R.A., D.M., J.P.F. and M.J.C.; formal analysis, R.M., R.A., D.M., J.P.F. and M.J.C.; investigation, M.J., R.M., J.P.F. and M.J.C.; resources, M.J., R.M., J.P.F. and M.J.C.; data curation, M.J., R.M., J.P.F. and M.J.C.; writing—original draft preparation, M.J., R.M., B.G., A.C., R.A., D.M., J.P.F. and M.J.C.; writing—review and editing, M.J., R.M., B.G., A.C., R.A., D.M., J.P.F. and M.J.C.; visualization, R.M., B.G., A.C., R.A., D.M., J.P.F. and M.J.C; supervision, R.M., J.P.F. and M.J.C.; project administration, M.J., R.M., J.P.F. and M.J.C.; funding acquisition, M.J., R.M., B.G., R.A., D.M., J.P.F. and M.J.C. All authors have read and agreed to the published version of the manuscript.

Funding

This work was supported by the Portuguese Foundation for Science and Technology, I.P., Grant/Award Number UIDB/04748/2020 and UIDP/04213/2020.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study. Written informed consent has been obtained from the patients to publish this paper.

Data Availability Statement

Not applicable.

Acknowledgments

The authors would like to thank the institution that agreed to participate in this study: Organização de Apoio e Solidariedade para a Integração Social. The authors would also like to thank Fátima Rosado and Sofia Ataíde for volunteering to help with data collection.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Schalock, R.; Luckasson, R.; Tassé, M. Intellectual Disability: Definition, Diagnosis, Classification, and Systems of Supports, 12th ed.; American Association on Intellectual and Developmental Disabilities: Washington, DC, USA, 2021. [Google Scholar]
  2. Sousa, C.P.G.; Luz, F.C. People with Intellectual Disability in Portugal—Report; Universidade Lusófona de Humanidades e Tecnologias: Lisboa, Portugal, 2019. [Google Scholar]
  3. Alberti, K.G.M.M.; Eckel, R.H.; Grundy, S.M.; Zimmet, P.Z.; Cleeman, J.I.; Donato, K.A.; Fruchart, J.-C.; James, W.P.T.; Loria, C.M.; Smith, S.C.; et al. Harmonizing the Metabolic Syndrome: A Joint Interim Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009, 120, 1640–1645. [Google Scholar] [CrossRef]
  4. Mottillo, S.; Filion, K.B.; Genest, J.; Joseph, L.; Pilote, L.; Poirier, P.; Rinfret, S.; Schiffrin, E.L.; Eisenberg, M.J. The Metabolic Syndrome and Cardiovascular Risk a Systematic Review and Meta-Analysis. J. Am. Coll. Cardiol. 2010, 56, 1113–1132. [Google Scholar] [CrossRef] [PubMed]
  5. Froehlich-Grobe, K.; Lee, J.; Washburn, R.A. Disparities in Obesity and Related Conditions among Americans with Disabilities. Am. J. Prev. Med. 2013, 45, 83–90. [Google Scholar] [CrossRef]
  6. Rimmer, J.H.; Yamaki, K.; Lowry, B.M.D.; Wang, E.; Vogel, L.C. Obesity and Obesity-Related Secondary Conditions in Adolescents with Intellectual/Developmental Disabilities. J. Intellect. Disabil. Res. 2010, 54, 787–794. [Google Scholar] [CrossRef]
  7. Baumbusch, J.; Mayer, S.; Phinney, A.; Baumbusch, S. Aging Together: Caring Relations in Families of Adults With Intellectual Disabilities. Gerontologist 2017, 57, 341–347. [Google Scholar] [CrossRef]
  8. Lavin, K.; Mcguire, B.; Hogan, M. Age of Death of People with an Intellectual Disability in Ireland. J. Intellect. Disabil. JOID 2006, 10, 155–164. [Google Scholar] [CrossRef]
  9. McCarron, M.; Carroll, R.; Kelly, C.; McCallion, P. Mortality Rates in the General Irish Population Compared to Those with an Intellectual Disability from 2003 to 2012. J. Appl. Res. Intellect. Disabil. 2015, 28, 406–413. [Google Scholar] [CrossRef] [PubMed]
  10. Dieckmann, F.; Giovis, C.; Offergeld, J. The Life Expectancy of People with Intellectual Disabilities in Germany. J. Appl. Res. Intellect. Disabil. 2015, 28, 373–382. [Google Scholar] [CrossRef]
  11. De Winter, C.F.; Magilsen, K.W.; van Alfen, J.C.; Willemsen, S.P.; Evenhuis, H.M. Metabolic Syndrome in 25% of Older People with Intellectual Disability. Fam. Pract. 2011, 28, 141–144. [Google Scholar] [CrossRef] [PubMed]
  12. Lee, K.; Cascella, M.; Marwaha, R. Intellectual Disability. In StatPearls; StatPearls Publishing: Treasure Island, FL, USA, 2022. [Google Scholar]
  13. Emerson, E.; Hatton, C.; Baines, S.; Robertson, J. The Physical Health of British Adults with Intellectual Disability: Cross Sectional Study. Int. J. Equity Health 2016, 15, 11. [Google Scholar] [CrossRef]
  14. Melville, C.A.; Hamilton, S.; Hankey, C.R.; Miller, S.; Boyle, S. The Prevalence and Determinants of Obesity in Adults with Intellectual Disabilities. Obes. Rev. 2007, 8, 223–230. [Google Scholar] [CrossRef]
  15. Draheim, C.C. Cardiovascular Disease Prevalence and Risk Factors of Persons with Mental Retardation. Ment. Retard. Dev. Disabil. Res. Rev. 2006, 12, 3–12. [Google Scholar] [CrossRef] [PubMed]
  16. Evenhuis, H.M. Medical Aspects of Ageing in a Population with Intellectual Disability: III. Mobility, Internal Conditions and Cancer. J. Intellect. Disabil. Res. 1997, 41 Pt 1, 8–18. [Google Scholar] [CrossRef] [PubMed]
  17. Janicki, M.P.; Dalton, A.J. Prevalence of Dementia and Impact on Intellectual Disability Services. Ment. Retard. 2000, 38, 276–288. [Google Scholar] [CrossRef] [PubMed]
  18. Jacinto, M.; Vitorino, A.S.; Palmeira, D.; Antunes, R.; Matos, R.; Ferreira, J.P.; Bento, T. Perceived Barriers of Physical Activity Participation in Individuals with Intellectual Disability—A Systematic Review. Healthcare 2021, 9, 1521. [Google Scholar] [CrossRef]
  19. McKeon, M.; Slevin, E.; Taggart, L. A Pilot Survey of Physical Activity in Men with an Intellectual Disability. J. Intellect. Disabil. 2013, 17, 157–167. [Google Scholar] [CrossRef]
  20. De Winter, C.F.; Bastiaanse, L.P.; Hilgenkamp, T.I.M.; Evenhuis, H.M.; Echteld, M.A. Cardiovascular Risk Factors (Diabetes, Hypertension, Hypercholesterolemia and Metabolic Syndrome) in Older People with Intellectual Disability: Results of the HA-ID Study. Res. Dev. Disabil. 2012, 33, 1722–1731. [Google Scholar] [CrossRef]
  21. De Winter, C.F.; Evenhuis, H.M. Cardiovascular disease risks in people with an intellectual disability: Causes and interventions. Ned. Tijdschr. Geneeskd. 2014, 158, A8002. [Google Scholar]
  22. Melville, C.A.; McGarty, A.; Harris, L.; Hughes-McCormack, L.; Baltzer, M.; McArthur, L.A.; Morrison, J.; Allan, L.; Cooper, S.-A. A Population-Based, Cross-Sectional Study of the Prevalence and Correlates of Sedentary Behaviour of Adults with Intellectual Disabilities. J. Intellect. Disabil. Res. 2018, 62, 60–71. [Google Scholar] [CrossRef]
  23. De Winter, C.F.; Hermans, H.; Evenhuis, H.M.; Echteld, M.A. Associations of Symptoms of Anxiety and Depression with Diabetes and Cardiovascular Risk Factors in Older People with Intellectual Disability. J. Intellect. Disabil. Res. 2015, 59, 176–185. [Google Scholar] [CrossRef]
  24. De Winter, C.; Bastiaanse, L.; Hilgenkamp, T.; Evenhuis, H.; Echteld, M. Overweight and Obesity in Older People with Intellectual Disability. Res. Dev. Disabil. 2011, 33, 398–405. [Google Scholar] [CrossRef] [PubMed]
  25. De Winter, C.F.; Magilsen, K.W.; van Alfen, J.C.; Penning, C.; Evenhuis, H.M. Prevalence of Cardiovascular Risk Factors in Older People with Intellectual Disability. Am. J. Intellect. Dev. Disabil. 2009, 114, 427–436. [Google Scholar] [CrossRef] [PubMed]
  26. Vohra, R.; Madhavan, S.; Sambamoorthi, U. Comorbidity Prevalence, Healthcare Utilization, and Expenditures of Medicaid Enrolled Adults with Autism Spectrum Disorders. Autism 2017, 21, 995–1009. [Google Scholar] [CrossRef] [PubMed]
  27. Cowley, P.M.; Ploutz-Snyder, L.L.; Baynard, T.; Heffernan, K.; Jae, S.Y.; Hsu, S.; Lee, M.; Pitetti, K.H.; Reiman, M.P.; Fernhall, B. Physical Fitness Predicts Functional Tasks in Individuals with Down Syndrome. Med. Sci. Sports Exerc. 2010, 42, 388–393. [Google Scholar] [CrossRef] [PubMed]
  28. Downs, J.; Jacoby, P.; Leonard, H.; Epstein, A.; Murphy, N.; Davis, E.; Reddihough, D.; Whitehouse, A.; Williams, K. Psychometric Properties of the Quality of Life Inventory-Disability (QI-Disability) Measure. Qual. Life Res. 2019, 28, 783–794. [Google Scholar] [CrossRef]
  29. Williams, K.; Jacoby, P.; Whitehouse, A.; Kim, R.; Epstein, A.; Murphy, N.; Reid, S.; Leonard, H.; Reddihough, D.; Downs, J. Functioning, Participation, and Quality of Life in Children with Intellectual Disability: An Observational Study. Dev. Med. Child Neurol. 2021, 63, 89–96. [Google Scholar] [CrossRef]
  30. Schalock, R.; Verdugo, M. Handbook on Quality of Life for Human Service Practitioners; American Association on Mental Retardation: Washington, DC, USA, 2002. [Google Scholar]
  31. American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription, 11th Spiral ed.; LWW: Philadelphia, PA, USA, 2021; ISBN 978-1-975150-18-1. [Google Scholar]
  32. World Medical Association. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA 2013, 310, 2191–2194. [Google Scholar] [CrossRef]
  33. Ferreira, J.P.; Matos, R.; Campos, M.J.; Monteiro, D.; Antunes, R.; Jacinto, M. Effects of Physical Exercise Program in Adults with Intellectual and Developmental Disabilities—A Study Protocol. J. Clin. Med. 2022, 11, 7485. [Google Scholar] [CrossRef]
  34. WHO. Consultation on Obesity 1999. In Obesity: Preventing and Managing the Global Epidemic: Report of a WHO Consultation; World Health Organization: Geneva, Switzerland, 2000. [Google Scholar]
  35. Havinga-Top, A.M.; Waninge, A.; van der Schans, C.P.; Jager-Wittenaar, H. Feasibility of Bioelectrical Impedance Analysis in Persons with Severe Intellectual and Visual Disabilities. Res. Dev. Disabil. 2015, 47, 126–134. [Google Scholar] [CrossRef]
  36. Muntner, P.; Shimbo, D.; Carey, R.M.; Charleston, J.B.; Gaillard, T.; Misra, S.; Myers, M.G.; Ogedegbe, G.; Schwartz, J.E.; Townsend, R.R.; et al. Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association. Hypertension 2019, 73, e35–e66. [Google Scholar] [CrossRef]
  37. Proietti, R.; di Fronso, S.; Pereira, L.A.; Bortoli, L.; Robazza, C.; Nakamura, F.Y.; Bertollo, M. Heart Rate Variability Discriminates Competitive Levels in Professional Soccer Players. J. Strength Cond. Res. 2017, 31, 1719–1725. [Google Scholar] [CrossRef] [PubMed]
  38. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart Rate Variability: Standards of Measurement, Physiological Interpretation and Clinical Use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation 1996, 93, 1043–1065. [Google Scholar] [CrossRef]
  39. World Health Organization. WHO Guidelines on Drawing Blood: Best Practices in Phlebotomy; World Health Organization: Geneva, Switzerland, 2010. [Google Scholar]
  40. Rikli, R.E.; Jones, C.J. Development and Validation of a Functional Fitness Test for Community-Residing Older Adults. J. Aging Phys. Act. 1999, 7, 129–161. [Google Scholar] [CrossRef]
  41. Hilgenkamp, T.; Wijck, R.; Evenhuis, H. Feasibility and Reliability of Physical Fitness Tests in Older Adults with Intellectual Disability: A Pilot Study. J. Intellect. Dev. Disabil. 2012, 37, 158–162. [Google Scholar] [CrossRef] [PubMed]
  42. Wouters, M.; van der Zanden, A.M.; Evenhuis, H.M.; Hilgenkamp, T.I.M. Feasibility and Reliability of Tests Measuring Health-Related Physical Fitness in Children With Moderate to Severe Levels of Intellectual Disability. Am. J. Intellect. Dev. Disabil. 2017, 122, 422–438. [Google Scholar] [CrossRef]
  43. Cabeza-Ruiz, R.; Alcántara-Cordero, F.J.; Ruiz-Gavilán, I.; Sánchez-López, A.M. Feasibility and Reliability of a Physical Fitness Test Battery in Individuals with Down Syndrome. Int. J. Environ. Res. Public Health 2019, 16, 2685. [Google Scholar] [CrossRef]
  44. Nasuti, G.; Stuart-Hill, L.; Temple, V.A. The Six-Minute Walk Test for Adults with Intellectual Disability: A Study of Validity and Reliability. J. Intellect. Dev. Disabil. 2013, 38, 31–38. [Google Scholar] [CrossRef]
  45. Pitetti, K.H. A Reliable Isokinetic Strength Test for Arm and Leg Musculature for Mildly Mentally Retarded Adults. Arch. Phys. Med. Rehabil. 1990, 71, 669–672. [Google Scholar]
  46. Oppewal, A.; Hilgenkamp, T.I.M. Adding Meaning to Physical Fitness Test Results in Individuals with Intellectual Disabilities. Disabil. Rehabil. 2020, 42, 1406–1413. [Google Scholar] [CrossRef]
  47. Winnick, J.P.; Short, F.X. Testes de Aptidão Física Para Jovens com Necessidades Especiais: Manual Brockport de Testes; Manole: Sao Paulo, Brazil, 2001; ISBN 978-85-204-1168-1. [Google Scholar]
  48. Guerreiro, M.; Silva, A.; Botelho, M. Adaptação à População Portuguesa Da Tradução Do “Mini Mental State Examination” (MMSE). Rev. Port. Neurol. 1994, 1, 9–10. [Google Scholar]
  49. Paiva, A.F.; Nolan, A.; Thumser, C.; Santos, F.H. Screening of Cognitive Changes in Adults with Intellectual Disabilities: A Systematic Review. Brain Sci. 2020, 10, 848. [Google Scholar] [CrossRef]
  50. Claes, C.; Van Hove, G.; van Loon, J.; Vandevelde, S.; Schalock, R.L. Quality of Life Measurement in the Field of Intellectual Disabilities: Eight Principles for Assessing Quality of Life-Related Personal Outcomes. Soc. Indic. Res. 2010, 98, 61–72. [Google Scholar] [CrossRef]
  51. Loon, J.; Claes, C.; Vandevelde, S.; Van Hove, G.; Schalock, R.L. Assessing Individual Support Needs to Enhance Personal Outcomes. Exceptionality 2010, 18, 193–202. [Google Scholar] [CrossRef]
  52. Simões, C.; Santos, S.; Biscaia, R. Validation of the Portuguese Version of the Personal Outcomes Scale. Int. J. Clin. Health Psychol. 2016, 16, 186–200. [Google Scholar] [CrossRef]
  53. Cohen, J.; Cohen, P.; West, S.G.; Aiken, L.S. Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences, 3rd ed.; Routledge: New York, NY, USA, 2002; ISBN 978-0-203-77444-1. [Google Scholar]
  54. Klein, S.; Allison, D.B.; Heymsfield, S.B.; Kelley, D.E.; Leibel, R.L.; Nonas, C.; Kahn, R. Waist Circumference and Cardiometabolic Risk: A Consensus Statement from Shaping America’s Health: Association for Weight Management and Obesity Prevention; NAASO, The Obesity Society; the American Society for Nutrition; and the American Diabetes Association. Am. J. Clin. Nutr. 2007, 85, 1197–1202. [Google Scholar] [CrossRef]
  55. Evenhuis, H.M.; Hermans, H.; Hilgenkamp, T.I.M.; Bastiaanse, L.P.; Echteld, M.A. Frailty and Disability in Older Adults with Intellectual Disabilities: Results from the Healthy Ageing and Intellectual Disability Study. J. Am. Geriatr. Soc. 2012, 60, 934–938. [Google Scholar] [CrossRef] [PubMed]
  56. Segal, M.; Eliasziw, M.; Phillips, S.; Bandini, L.; Curtin, C.; Kral, T.V.E.; Sherwood, N.E.; Sikich, L.; Stanish, H.; Must, A. Intellectual Disability Is Associated with Increased Risk for Obesity in a Nationally Representative Sample of U.S. Children. Disabil. Health J. 2016, 9, 392–398. [Google Scholar] [CrossRef]
  57. Hsieh, K.; Rimmer, J.H.; Heller, T. Obesity and Associated Factors in Adults with Intellectual Disability. J. Intellect. Disabil. Res. 2014, 58, 851–863. [Google Scholar] [CrossRef]
  58. Pronk, N.P.; Anderson, L.H.; Crain, A.L.; Martinson, B.C.; O’Connor, P.J.; Sherwood, N.E.; Whitebird, R.R. Meeting Recommendations for Multiple Healthy Lifestyle Factors. Prevalence, Clustering, and Predictors among Adolescent, Adult, and Senior Health Plan Members. Am. J. Prev. Med. 2004, 27, 25–33. [Google Scholar] [CrossRef]
  59. Cooper, S.-A.; McLean, G.; Guthrie, B.; McConnachie, A.; Mercer, S.; Sullivan, F.; Morrison, J. Multiple Physical and Mental Health Comorbidity in Adults with Intellectual Disabilities: Population-Based Cross-Sectional Analysis. BMC Fam. Pract. 2015, 16, 110. [Google Scholar] [CrossRef]
  60. Doody, C.M.; Doody, O. Health Promotion for People with Intellectual Disability and Obesity. Br. J. Nurs. 2012, 21, 460–465. [Google Scholar] [CrossRef]
  61. Kildal, E.; Stadskleiv, K.; Boysen, E.S.; Øderud, T.; Dahl, I.-L.; Seeberg, T.M.; Guldal, S.; Strisland, F.; Morland, C.; Hassel, B. Increased Heart Rate Functions as a Signal of Acute Distress in Non-Communicating Persons with Intellectual Disability. Sci. Rep. 2021, 11, 6479. [Google Scholar] [CrossRef] [PubMed]
  62. Reimers, A.K.; Knapp, G.; Reimers, C.-D. Effects of Exercise on the Resting Heart Rate: A Systematic Review and Meta-Analysis of Interventional Studies. J. Clin. Med. 2018, 7, 503. [Google Scholar] [CrossRef] [PubMed]
  63. Ledowski, T.; Stein, J.; Albus, S.; MacDonald, B. The Influence of Age and Sex on the Relationship between Heart Rate Variability, Haemodynamic Variables and Subjective Measures of Acute Post-Operative Pain. Eur. J. Anaesthesiol. EJA 2011, 28, 433. [Google Scholar] [CrossRef] [PubMed]
  64. Waldstein, S.R.; Kop, W.J.; Schmidt, L.A.; Haufler, A.J.; Krantz, D.S.; Fox, N.A. Frontal Electrocortical and Cardiovascular Reactivity during Happiness and Anger. Biol. Psychol. 2000, 55, 3–23. [Google Scholar] [CrossRef]
  65. Nunan, D.; Sandercock, G.R.H.; Brodie, D.A. A Quantitative Systematic Review of Normal Values for Short-Term Heart Rate Variability in Healthy Adults. Pacing Clin. Electrophysiol. 2010, 33, 1407–1417. [Google Scholar] [CrossRef]
  66. Meule, A.; Fath, K.; Real, R.G.; Sütterlin, S.; Vögele, C.; Kübler, A. Quality of Life, Emotion Regulation, and Heart Rate Variability in Individuals with Intellectual Disabilities and Concomitant Impaired Vision. Psychol. Well-Being Theory Res. Pract. 2013, 3, 1. [Google Scholar] [CrossRef]
  67. Kleiger, R.E.; Stein, P.K.; Bigger, J.T. Heart Rate Variability: Measurement and Clinical Utility. Ann. Noninvasive Electrocardiol. 2005, 10, 88–101. [Google Scholar] [CrossRef]
  68. Axmon, A.; Ahlström, G.; Höglund, P. Prevalence and Treatment of Diabetes Mellitus and Hypertension among Older Adults with Intellectual Disability in Comparison with the General Population. BMC Geriatr. 2017, 17, 272. [Google Scholar] [CrossRef]
  69. Gazizova, D.; Puri, B.K.; Singh, I.; Dhaliwal, R. The Overweight: Obesity and Plasma Lipids in Adults with Intellectual Disability and Mental Illness. J. Intellect. Disabil. Res. 2012, 56, 895–901. [Google Scholar] [CrossRef]
  70. Graham, A.; Reid, G. Physical Fitness of Adults with an Intellectual Disability: A 13-Year Follow-up Study. Res. Q. Exerc. Sport 2000, 71, 152–161. [Google Scholar] [CrossRef] [PubMed]
  71. Skowroński, W.; Horvat, M.; Nocera, J.; Roswal, G.; Croce, R. Eurofit Special: European Fitness Battery Score Variation among Individuals with Intellectual Disabilities. Adapt. Phys. Act. Q. 2009, 26, 54–67. [Google Scholar] [CrossRef]
  72. Camargo Rojas, D.A.; Rodriguez, M.A.; Camargo Rojas, D.A.; Rodriguez, M.A. Physical Fitness and Indicators of Cardiovascular Risk in Population with Intellectual Disability. Rev. Cienc. Salud 2020, 18, 10–23. [Google Scholar] [CrossRef]
  73. Izquierdo-Gomez, R.; Martínez-Gómez, D.; Tejero-Gonzalez, C.M.; Cabanas-Sánchez, V.; Ruiz Ruiz, J.; Veiga, Ó.L. Are Poor Physical Fitness and Obesity Two Features of the Adolescent with Down Syndrome? Nutr. Hosp. 2013, 28, 1348–1351. [Google Scholar] [CrossRef]
  74. Wouters, M.; Evenhuis, H.M.; Hilgenkamp, T.I.M. Physical Fitness of Children and Adolescents with Moderate to Severe Intellectual Disabilities. Disabil. Rehabil. 2020, 42, 2542–2552. [Google Scholar] [CrossRef] [PubMed]
  75. Secchi, J.D.; García, G.C.; España-Romero, V.; Castro-Piñero, J. Physical Fitness and Future Cardiovascular Risk in Argentine Children and Adolescents: An Introduction to the ALPHA Test Battery. Arch. Argent Pediatr. 2014, 112, 132–140. [Google Scholar] [CrossRef] [PubMed]
  76. Oppewal, A.; Hilgenkamp, T.I.M.; van Wijck, R.; Schoufour, J.D.; Evenhuis, H.M. Physical Fitness Is Predictive for a Decline in Daily Functioning in Older Adults with Intellectual Disabilities: Results of the HA-ID Study. Res. Dev. Disabil. 2014, 35, 2299–2315. [Google Scholar] [CrossRef]
  77. Oppewal, A.; Hilgenkamp, T.I.M. Physical Fitness Is Predictive for 5-Year Survival in Older Adults with Intellectual Disabilities. J. Appl. Res. Intellect. Disabil. 2019, 32, 958–966. [Google Scholar] [CrossRef]
  78. Lahtinen, U.; Rintala, P.; Malin, A. Physical Performance of Individuals with Intellectual Disability: A 30 Year Follow Up. Adapt. Phys. Act. Q. 2007, 24, 125–143. [Google Scholar] [CrossRef]
  79. Cadore, E.L.; Brentano, M.A.; Lhullier, F.L.R.; Kruel, L.F.M. Fatores relacionados com as respostas da testosterona e do cortisol ao treinamento de força. Rev. Bras. Med. Esporte 2008, 14, 74–78. [Google Scholar] [CrossRef]
  80. Barut, C.; Ozer, C.M.; Sevinc, O.; Gumus, M.; Yunten, Z. Relationships between Hand and Foot Preferences. Int. J. Neurosci. 2007, 117, 177–185. [Google Scholar] [CrossRef]
  81. Reiss, M.; Reiss, G. Motor assymetry. Fortschr. Neurol. Psychiatr. 2000, 68, 70–79. [Google Scholar] [CrossRef] [PubMed]
  82. Neder, J.A.; Nery, L.E.; Shinzato, G.T.; Andrade, M.S.; Peres, C.; Silva, A.C. Reference Values for Concentric Knee Isokinetic Strength and Power in Nonathletic Men and Women from 20 to 80 Years Old. J. Orthop. Sports Phys. Ther. 1999, 29, 116–126. [Google Scholar] [CrossRef] [PubMed]
  83. Raulino, A.G.D.; Brito, C.J.; Barros, J.F. Efeito do Treinamento com Pesos nas Atividades da Vida Diária em Deficientes Intelectuais. Rev. Bras. Ciências Esporte 2014, 36, 13–25. [Google Scholar]
  84. Bofosa, T.; Miangindula, B.; Kam, E.; Nkiama, C.; Bumoko, G. Consequences of the Absence of an Adapted Physical Activities Program on the Physical Fitness of Sedentary Children and Adolescents with Intellectual Disability. Sci. Sports 2019, 34, 395–400. [Google Scholar] [CrossRef]
  85. Cuesta-Vargas, A.; Hilgenkamp, T. Reference Values of Grip Strength Measured with a Jamar Dynamometer in 1526 Adults with Intellectual Disabilities and Compared to Adults without Intellectual Disability. PLoS ONE 2015, 10, e0129585. [Google Scholar] [CrossRef]
  86. Wang, Y.-C.; Bohannon, R.W.; Li, X.; Sindhu, B.; Kapellusch, J. Hand-Grip Strength: Normative Reference Values and Equations for Individuals 18 to 85 Years of Age Residing in the United States. J. Orthop. Sports Phys. Ther. 2018, 48, 685–693. [Google Scholar] [CrossRef]
  87. Smail, K.; Horvat, M. Relationship of Muscular Strength on Work Performance in High School Students with Mental Retardation. Educ. Train. Dev. Disabil. 2006, 41, 410–419. [Google Scholar]
  88. Sousa-Santos, A.R.; Amaral, T.F. Differences in Handgrip Strength Protocols to Identify Sarcopenia and Frailty—A Systematic Review. BMC Geriatr. 2017, 17, 238. [Google Scholar] [CrossRef]
  89. Borji, R.; Zghal, F.; Zarrouk, N.; Martin, V.; Sahli, S.; Rebai, H. Neuromuscular Fatigue and Recovery Profiles in Individuals with Intellectual Disability. J. Sport Health Sci. 2019, 8, 242–248. [Google Scholar] [CrossRef]
  90. Golubović, Š.; Maksimović, J.; Golubović, B.; Glumbić, N. Effects of Exercise on Physical Fitness in Children with Intellectual Disability. Res. Dev. Disabil. 2012, 33, 608–614. [Google Scholar] [CrossRef] [PubMed]
  91. Jacinto, M.Â.; Domingos, C.; Antunes, R.; Vitorino, A.; Rodrigues, J. O papel do técnico de exercício físico como promotor da qualidade de vida na Dificuldade Intelectual e Desenvolvimental. Motricidade 2022, 18, 486–495. [Google Scholar] [CrossRef]
  92. Jacinto, M.; Oliveira, R.; Brito, J.P.; Martins, A.D.; Matos, R.; Ferreira, J.P. Prescription and Effects of Strength Training in Individuals with Intellectual Disability—A Systematic Review. Sports 2021, 9, 125. [Google Scholar] [CrossRef]
  93. Stern, Y. What Is Cognitive Reserve? Theory and Research Application of the Reserve Concept. J. Int. Neuropsychol. Soc. 2002, 8, 448–460. [Google Scholar] [CrossRef] [PubMed]
  94. Sheehan, R.; Ali, A.; Hassiotis, A. Dementia in Intellectual Disability. Curr. Opin. Psychiatry 2014, 27, 143–148. [Google Scholar] [CrossRef]
  95. Englund, A.; Jonsson, B.; Zander, C.S.; Gustafsson, J.; Annerén, G. Changes in Mortality and Causes of Death in the Swedish Down Syndrome Population. Am. J. Med. Genet. A 2013, 161, 642–649. [Google Scholar] [CrossRef] [PubMed]
  96. Alty, J.; Farrow, M.; Lawler, K. Exercise and Dementia Prevention. Pract. Neurol. 2020, 20, 234–240. [Google Scholar] [CrossRef]
  97. Heyn, P.; Abreu, B.C.; Ottenbacher, K.J. The Effects of Exercise Training on Elderly Persons with Cognitive Impairment and Dementia: A Meta-Analysis. Arch. Phys. Med. Rehabil. 2004, 85, 1694–1704. [Google Scholar] [CrossRef]
  98. Wang, S.; Liu, H.-Y.; Cheng, Y.-C.; Su, C.-H. Exercise Dosage in Reducing the Risk of Dementia Development: Mode, Duration, and Intensity—A Narrative Review. Int. J. Environ. Res. Public Health 2021, 18, 13331. [Google Scholar] [CrossRef]
  99. Pestana, M.B.; Barbieri, F.A.; Vitório, R.; Figueiredo, G.A.; Mauerberg-deCastro, E. Effects of Physical Exercise for Adults with Intellectual Disabilities: A Systematic Review. J. Phys. Educ. 2018, 29. [Google Scholar] [CrossRef]
  100. Pérez-Cruzado, D.; Cuesta-Vargas, A.I. Changes on Quality of Life, Self-Efficacy and Social Support for Activities and Physical Fitness in People with Intellectual Disabilities through Multimodal Intervention. Eur. J. Spec. Needs Educ. 2016, 31, 553–564. [Google Scholar] [CrossRef]
  101. Carbó-Carreté, M.; Guàrdia-Olmos, J.; Giné, C.; Schalock, R.L. A Structural Equation Model of the Relationship between Physical Activity and Quality of Life. Int. J. Clin. Health Psychol. 2016, 16, 147–156. [Google Scholar] [CrossRef] [PubMed]
  102. Jacinto, M.Â.; Oliveira, R.; Brito, J.; Simões, C.; Vitorino, A. Influência da aptidão física na perceção de bem-estar físico e qualidade de vida em indivíduos com Dificuldade Intelectual e Desenvolvimental. Motricidade 2022, 18, 379–387. [Google Scholar] [CrossRef]
Table 1. Demographics and participant characteristics.
Table 1. Demographics and participant characteristics.
21 ParticipantsMean ± SDMedianMin–Max
Age (years)42.81 ± 11.1810.9923.00–58.00
Height (cm)160.05 ± 7.93160.40138.00–171.00
Weight (kg)74.11 ± 16.1175.5048.60–105.30
WomenMean ± SDMedianMin–max
Age (years)43.50 ± 12.3746.5023.00–58.00
Height (cm)157.36 ± 9.45160.00138.00–165.50
Weight (kg)79.42 ± 15.6779.7552.10–105.30
MenMean ± SDMedianMin–max
Age (years)42.18 ± 10.1545.0027.00–56.00
Height (cm)162.50 ± 5.63160.80155.40–171.00
Weight (kg)69.30 ± 15.6472.0048.60–93.30
Table 2. Body composition results.
Table 2. Body composition results.
Mean ± SDMedianMin–MaxDifferences between Limbs
BMI (kg/m2)29.13 ± 6.8629.20 *19.10–40.90
Waist circumference (cm)92.90 ± 15.4593.60 *64.07–115.00
Total body water (L)31.58 ± 4.1831.05 *25.40–38.90
Proteins (kg)8.37 ± 1.168.15 *6.70–10.50
Minerals (kg)2.83 ± 0.432.862.11–3.64
Fat mass (kg)36.64 ± 12.7040.20 *14.80–56.90
Muscle mass (kg)23.30 ± 3.5122.75 *18.20–29.50
Lean mass right arm (kg)2.57 ± 0.852.341.75–4.69p > 0.05
Lean mass left arm (kg)2.36 ± 0.402.331.82–3.11
Lean trunk mass (kg)20.76 ± 3.3620.2516.50–26.60
Lean mass right leg (kg)6.22 ± 0.936.174.80–7.67p > 0.05
Lean mass left leg (kg)6.17 ± 0.946.05 *4.46–7.48
Fat right arm (kg)3.29 ± 1.773.70 *0.90–6.60p > 0.05
Fat Left arm (kg)3.46 ± 1.623.75 *1–60.60
Trunk fat (kg)18.38 ± 5.6820.00 *7.60–25.20
Fat right leg (kg)4.96 ± 1.835.45 *2.10–8.20p > 0.05
Fat left leg (kg)4.96 ± 1.815.45 *2.10–8.20
Intracellular water (L)19.38 ± 2.6718.95 *15.50–24.10
Extracellular water (L)12.20 ± 1.5312.259.90–14.80
Phase angle5.20 ± 1.334.70 *3.50–8.50
* Difference between sexes; BMI, body mass index.
Table 3. General health status results.
Table 3. General health status results.
Mean ± SDMedianMin–Max
Systolic blood pressure (mm Hg)124.42 ± 18.75121.00101.00–168.00
Diastolic blood pressure (mm Hg)79.95 ± 11.8580.0063.00–108.00
Maximum heart rate (mm Hg)176.99 ± 9.79176.50149.80–191.90
Resting heart rate (mm Hg)74.28 ± 14.1372.0052.00–113.00
SDNN (ms)35.72 ± 19.6832.182.95–77.44
Mean RR (ms)811.13 ± 161.78794.34516.42–1174.20
RMSSD (ms)25.71 ± 15.8523.995.86–66.62
pNN50 (%)6.81 ± 8.771.030.00–27.14
LF (log)5.56 ± 1.205.523.03–7.63
HF (log)5.10 ± 1.455.322.50–7.61
LF (n.u.)58.77 ± 23.2462.9515.48–94.51
HF (n.u.)41.13 ± 21.2836.589.76–71.75
LF/HF ratio3.07 ± 4.051.690.18–17.26
Glycemia (mg/dL)96.23 ± 24.7593.0061.00–154.00
Total Cholesterol (mg/dL)190.19 ± 43.70192.00107.00–261.00
Triglycerides (mg/dL)137.19 ± 69.32114.0037.00–337.00
Mean RR, mean of the RR intervals in ms; SDNN, standard deviation of RR intervals in ms; RMSSD, root mean square of successive RR interval differences in ms; pNN50, percentage of successive RR intervals that differ by more than 50 ms; LF, absolute power of the low-frequency band, 0.04–0.15 Hz, in ms2; HF, absolute power of the high-frequency band, 0.15–0.4 Hz, in ms2; LF/HF, ratio of LF-to-HF power.
Table 4. Functional capacity results.
Table 4. Functional capacity results.
Mean ± SDMedianMin–Max
30 s chair test (s)13.52 ± 3.9013.004.00–20.00
timed up and go test (s)8.82 ± 4.067.084.75–17.75
6 min walk test (m)474.19 ± 69.68456.00326.00–592.00
Table 5. Neuromuscular results (isokinetic dynamometer).
Table 5. Neuromuscular results (isokinetic dynamometer).
Extension 60 °/sFlexion 60 °/sExtension 120 °/sFlexion 120 °/s
Peak TorqueRightLeftRightLeftRightLeftRightLeft
Mean59.00 ± 40.1168.18 ± 44.1728.38 ± 23.5931.08 ± 23.5847.37 ± 35.0251.06 ± 37.0923.15 ± 21.9523.44 ± 21.94
Median55.2062.2020.0527.4038.2041.4040.0041.50
Min–max6.90–182.705.10–211.100.40–90.400.50–90.200.00–161.300.00–171.000.00–88.901.50–87.00
Table 6. Neuromuscular results (manual dynamometer and 3 kg throw ball test).
Table 6. Neuromuscular results (manual dynamometer and 3 kg throw ball test).
Mean ± SDMedianMin–Max
Manual dynamometer (kg)20.06 ± 7.5619.808.70–40.20
3 kg throw ball test (m)2.27 ± 0.852.20 *1.19–4.33
* Difference between sexes.
Table 7. Dementia/cognitive function and quality of life results.
Table 7. Dementia/cognitive function and quality of life results.
Mean ± SDMedianMin–Max
Mini-mental state examination (score)21.42 ± 5.6122.007.00–30.00
Quality of life (score)86.61 ± 8.318571–101
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Jacinto, M.; Matos, R.; Gomes, B.; Caseiro, A.; Antunes, R.; Monteiro, D.; Ferreira, J.P.; Campos, M.J. Physical Fitness Variables, General Health, Dementia and Quality of Life in Individuals with Intellectual and Developmental Disabilities: A Cross-Sectional Study. Healthcare 2023, 11, 2688. https://doi.org/10.3390/healthcare11192688

AMA Style

Jacinto M, Matos R, Gomes B, Caseiro A, Antunes R, Monteiro D, Ferreira JP, Campos MJ. Physical Fitness Variables, General Health, Dementia and Quality of Life in Individuals with Intellectual and Developmental Disabilities: A Cross-Sectional Study. Healthcare. 2023; 11(19):2688. https://doi.org/10.3390/healthcare11192688

Chicago/Turabian Style

Jacinto, Miguel, Rui Matos, Beatriz Gomes, André Caseiro, Raul Antunes, Diogo Monteiro, José Pedro Ferreira, and Maria João Campos. 2023. "Physical Fitness Variables, General Health, Dementia and Quality of Life in Individuals with Intellectual and Developmental Disabilities: A Cross-Sectional Study" Healthcare 11, no. 19: 2688. https://doi.org/10.3390/healthcare11192688

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