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

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overweight [15]. This prevalence is similar to that in other countries [14, 16]. Moreover, personswith ID are often not sufficiently active to achieve health benefits [14, 16, 18, 19], and more than50 % of the persons with ID of all age categories in Europe have a sedentary lifestyle [20]. As aconsequence, these persons may have poor physical fitness [14, 16].Similar to individuals with ID, persons with visual impairments display poor performanceon locomotor skills [21] and have low levels of habitual activity [22], resulting in poor physicalfitness when compared to the control group, in this case persons with normal eyesight [23, 24].Furthermore, persons displaying a combination of severe or profound intellectual disability anda visual impairment are particularly at risk to develop deficits in both locomotor skills as in dailyfunctioning [7]. The combination of these findings puts forward the suggestion that personshaving severe or profound intellectual and visual disabilities are likely to display insufficientphysical fitnessTerminology relating to persons with severe or profound IDA wide range of terms is being used to describe persons having a combination of severe orprofound intellectual and additional disabilities. The persons studied in this thesis have severe orprofound intellectual as well as visual disabilities. In general, the study population is referred toas persons with severe or profound intellectual and multiple disabilities (SPIMD). In the studiesexamining a population consisting in majority of persons with severe intellectual disabilities,the term severe intellectual and multiple disabilities (SIMD) is used. In the studies examininga population consisting in majority of persons with profound intellectual disabilities, the termprofound intellectual and multiple disabilities (PIMD) is used. The term ‘multiple’ indicateslocomotor disabilities, neurological problems, sensory disabilities, and/or problems with foodingestion.As locomotor skills may influence protocols for measuring physical fitness, it is useful to classifypersons with severe or profound ID according to their locomotor skills. The Gross Motor FunctionClassification System (GMFCS) [25] is a five-level system used to classify the locomotor skillsof people with physical disabilities and is also applicable for persons with ID. Participants witha “Level I” classification can generally walk without restrictions but tend to have limitations insome more advanced motor skills. Participants with a “Level II” classification can walk with slightrestrictions and do not spontaneously increase their speed during walking. Participants with a“Level III” are only able to walk with walking devices and have restrictions in walking outside aswell as in their living environment. Participants with a “Level IV” have limited mobility, but mightbe able to stand during transfers. Usually they use a wheelchair, which they may drive themselvesby hand or by assistive technology. Participants with a “Level V” classification generally havevery limited mobility, even with the use of assistive technology. These participants always use awheelchair.It is often assumed that persons with profound ID automatically have low locomotor levelsand are not able to walk. However, the ability to walk varies considerably in persons with severeID as well as in persons with profound ID. For example, 75 percent of persons with severe ID isable to walk at least with walking devices (GMFCS I-III), whereas 25 percent is not able to walk(GMFCS IV-V). Moreover, 56 percent of persons with profound ID is able to walk at least withwalking devices (GMFCS I-III), whereas 44 percent is not able to walk (GMFCS IV-V). Thus, contraryto common beliefs, it is necessary to perform research in persons with severe or profound ID yetranging in GMFCS levels from I to V.Chapter 1 | 11
Physical fitness and persons with both severe or profound ID andvisual impairmentAs a sufficient physical fitness level and physical activity improve health [26], and sufficienthealth in turn improves well-being and quality of life [27, 28, 29], it is imperative to gaincomprehensive insight into the physical fitness of persons with SPIMD.However, the feasibility and reliability of physical fitness measurements and tests in participantswith SPIMD have until now not been properly scrutinized, resulting in little reliable knowledge onthe physical fitness levels and locomotor skills of persons with SPIMD.Due to limitations both in intellectual functioning as in adaptive behaviour related toSPIMD, the level of health-related physical fitness is difficult to quantify in a feasible and reliablemanner [1]. Therefore, improving feasibility of physical fitness tests in persons with SPIMD needsto be prioritized. Persons with SPIMD are not accustomed to the assessments, have difficultycomprehending what is required of them [30] and often cannot understand instructions [3].Furthermore, persons with visual disabilities cannot see how test tasks need to be performed [4],hence showing them how to perform the task at hand is useless. In general, if a participant doesnot understand the tasks within a certain test, the test will automatically fail to provide a realisticimpression of the capabilities of the participant, rendering the test invalid. Thus, test instructionsfor persons with SPIMD require our special focus.Other factors of influence when determining the feasibility, reliability and validity of physicalfitness tests in persons with SPIMD are the prevalence of locomotor disabilities and motivationalproblems. Adapted test procedures and specific inclusion criteria are required because personswith intellectual, visual, and locomotor disabilities are not able to stand straight or to standat all [31]. Also, persons with SPIMD are often not motivated to exert themselves fully, whichnecessitates adjustments to and familiarization with test protocols.Since physical fitness is related to physical activity [26], it is important to gain insight intothe physical activity level in persons with SPIMD. However, as almost 40 % of SPIMD populationis simply not able to walk, walking fails to be an adequate representation of a person’s overallactivity level [32].Moreover, the presumed low levels of activity in persons with such profound disabilitiesare often not accurately presented by measurement devices, like activity monitors, which arerelatively insensitive [32]. Heart rate monitoring may be an indicator of activity levels assuming arelationship between activity intensity and heart rate [33, 34]. Heart rate monitoring appears tobe sufficiently valid for creating broad physical activity categories (e.g. highly active, somewhatactive, sedentary) [35]. However, a proper method for dating heart rate patterns in persons withPIMD, as well as the proper correlation between heart rate monitoring and activity levels for thisspecific group have so far not been examined.12 | Chapter 1
Page 2 and 3: Measuring physical fitnessin person
Page 4: Rijksuniversiteit GroningenMeasurin
Page 10 and 11: Chapter 1IntroductionChapter 1 | 9
Page 14 and 15: Theoretical framework of the studyI
Page 16 and 17: Components of physical fitnessThe a
Page 18 and 19: Therefore, a study is put forward w
Page 20 and 21: 2002;40:436-444.19 Temple VA, Frey
Page 22 and 23: 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
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and whether motivation influenced t
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Table 3. Mean peak heart rate achie
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AcknowledgementsThis research was f
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21 Hopkins WG, Gaeta H, Thomas AC,
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Chapter 5Psychometric quality of a
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IntroductionIntellectual disability
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Exclusion criteria were mental or p
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participant had fulfilled the task.
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Table 2. Descriptive results peak h
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Table 3. Test-retest reliability of
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Table 4. Correlation scored motivat
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preceding GXT results on HR peak. G
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References1 Schalock R, Brown I, Br
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37 Stanish HI, Temple VA, Frey GC.
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Chapter 6Feasibility and reliabilit
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IntroductionLocomotor skills in peo
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this study was to evaluate the feas
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obtained from the legal representat
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Modified Berg Balance Scale scoresI
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Modified Berg Balance Scale scoresT
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References1 Van Erkelens-Zwets JHJ
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39 Dorai-Raj S. Binomial Confidence
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Chapter 7Feasibility, test-retest r
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IntroductionPersons with profound i
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DesignThe muscle tone and spasticit
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Interrater reliabilityFirstly, to d
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Table 3. Summary of the statistical
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Table 6. Summary of the statistical
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RecommendationsThe feasibility of c
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18 Gielen EJJM. Is spasticiteit te
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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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