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

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48 persons18 persons lacked permission from representatives30 persons4 persons excluded for medical/behavioral reasons26 persons2 persons excluded at the time of the measurements24 personsFigure 1. Sampling scheme of subjects included in the studyAll participants were classified according to the GMFCS [19]. Furthermore, visual and auditiveimpairments of the participants were classified according to WHO guidelines [4]: a distinctionwas made between being severely partially sighted and being partially sighted as well as betweensevere hearing loss, slight hearing loss and normal hearing. Spasticity was classified as unilateral,bilateral or unknown [31]. Orthopedic defects were used as an indicator of locomotor disabilitiesand classified as present or not present.Ethical statementThis study was performed in agreement with the guidelines of the Helsinki Declaration as revisedin 1975. Permission to carry out the study was obtained from the institutional ethics committee.Informed consent was obtained from representatives of the participants, because the participantswere not able to give consent. The measurements were performed in accordance with thebehavioural code section entitled ‘Resistance among people with an intellectual disability in theframework of the Act Governing Medical-Scientific Research Involving Humans’ [32]. Consistentdistress or unhappiness was interpreted as a sign of lack of assent and further participation in thestudy was reconsidered.Study designHeart rate patterns were measured in each participant 8 hours a day for a period of six days.Every 15 minutes measurements were conducted, resulting in a total amount of measurements aday of 32 (8 hours, 4 times 15 minutes). 5 Out of the 6 test days were weekly, the remaining dayfell in the weekend. Parallel with heart rate measurements, physical activities were registeredusing direct observation, noted down in score lists.MeasuresHeart rate patterns were measured with a heart rate monitor (Polar RS 800, Kempele, Finland)whose heartbeat data were transferred later to a computer. Heart rate was monitored in everyparticipant during 6 days during 8 hours a day.Chapter 8 | 125
Data regarding physical activity were registered with the use of a questionnaire, which wasfilled out by both personal caregivers at the living group as support staff of the activity centre.Physical activity was coded as ‘Targeted physical activity Yes’ or ‘Targeted physical activity No’.Moving with the wheelchair inside or outside, transfer, active sitting without support, gymnasticswith a gymnastic instructor, physical therapy, playing with a ball, and ‘dancing’ on music were allexamples of ‘Targeted physical activity Yes’. Listening to music, watching television or lying downon a bed were all examples of “Targeted physical activity No’.Data analysisHeart rate zonesPeak heart rate, rest heart rate and heart rate reserves differ for each person, which makes themdifficult to compare. By calculating heart rate zones according to the equation of Karvonen [33], itis possible to compare the zones of the participants with each other.Heart rate zones are calculated as follows. First, each participant’s peak heart rate wasestimated using the formula of Fernhall [34] for participants with intellectual disabilities: 210 –0.56 (age) – 15.5. Due to the motor disabilities of the participants, no other non-invasive measurecould be performed. Secondly, the participants resting heart rate was determined by taking themedian of fifteen morning heart rate measurements. Thirdly, using the participants resting heartrate, the heart rate reserve was calculated by subtracting resting heart rate of estimated peakheart rate. Finally, the heart rate reserve was divided in 10 zones, each zone consisting of 10%of the heart rate reserve. The heart rate of a participant during each 15 minutes was classified inthese zones. For instance: resting heart rate of 50 beats per minute (bpm), maximum heart rate of180 bpm; heart rate reserve is 130 bpm; each heart rate zone exists of 13 heart rates, the first zoneis from 50 to 63; the second from 63 to 76; and so on (Table 1).Table 1. Example of the heart rate zones for healthy personsHeart Rate Zone Activity Percentage of heart rate reserve (HRV)1 50-63 Rest 1-102 63-77 10-203 77-90 Quiet moving 20-304 90-103 30-405 103-116 Moderately intensive activity 40-506 116-129 ACSM guideline of healthy physical activity 50-607 129-142 Intensive activity 60-708 142-155 70-809 155-168 Very intensive activity 80-9010 168-180 90-100Patterns and classes in heart rateHeart rate of the 24 participants was measured eight hours a day during six days, withmeasurements being conducted every 15 minutes. In order to determine the activity levels ofpersons with PIMD compared with ACSM guidelines of healthy physical activity, an overview ofthe heart rate zones is presented, along with a day to day outline of the mean prevalence of heartrate zones of the participants.126 | Chapter 8
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Measuring physical fitnessin person
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Rijksuniversiteit GroningenMeasurin
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Chapter 1IntroductionChapter 1 | 9
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overweight [15]. This prevalence is
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Theoretical framework of the studyI
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Components of physical fitnessThe a
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Therefore, a study is put forward w
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2002;40:436-444.19 Temple VA, Frey
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Chapter 2Feasibility and reliabilit
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IntroductionPhysical fitness and he
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GMFCS was presented to the investig
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Body weightTo determine the body we
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Table 1 Results of Wilcoxon rank te
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Calculation of heightThe mean (SD)
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DiscussionThe results of our study
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References1 Bouchard C, Shepard RJ,
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37 Rimmer J, Kelly LE, Rosentswieg
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Chapter 3Measuring waist circumfere
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IntroductionChildren and adults wit
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participants. These calculations as
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Data analysisThe data were analyzed
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Table 2. Simple regression analysis
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Chapter 4Feasibility and reliabilit
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IntroductionPeople with intellectua
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Eighty representatives gave permiss
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3) The measurement procedure: The m
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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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Page 78 and 79: Table 2. Descriptive results peak h
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Page 82 and 83: Table 4. Correlation scored motivat
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Page 86 and 87: References1 Schalock R, Brown I, Br
Page 88 and 89: 37 Stanish HI, Temple VA, Frey GC.
Page 90 and 91: Chapter 6Feasibility and reliabilit
Page 92 and 93: IntroductionLocomotor skills in peo
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Page 96 and 97: obtained from the legal representat
Page 98 and 99: Modified Berg Balance Scale scoresI
Page 100 and 101: Modified Berg Balance Scale scoresT
Page 102 and 103: References1 Van Erkelens-Zwets JHJ
Page 104 and 105: 39 Dorai-Raj S. Binomial Confidence
Page 106 and 107: Chapter 7Feasibility, test-retest r
Page 108 and 109: IntroductionPersons with profound i
Page 110 and 111: DesignThe muscle tone and spasticit
Page 112 and 113: Interrater reliabilityFirstly, to d
Page 114 and 115: Table 3. Summary of the statistical
Page 116 and 117: Table 6. Summary of the statistical
Page 118 and 119: RecommendationsThe feasibility of c
Page 120 and 121: 18 Gielen EJJM. Is spasticiteit te
Page 122 and 123: Chapter 8Heart Rate Pattern as an I
Page 124 and 125: IntroductionIt is important to gain
Page 128 and 129: Furthermore, the mean and the range
Page 130 and 131: Table 3. Day-to-day outline of the
Page 132 and 133: Relation between heart rate pattern
Page 134 and 135: patterns in this study we can concl
Page 136 and 137: References1 Emerson E. Underweight,
Page 138 and 139: 38 Multilevel Models Project (2004)
Page 140 and 141: Chapter 9General DiscussionChapter
Page 142 and 143: on this. To sum up, testing in pers
Page 144 and 145: for future research it is recommend
Page 146 and 147: studies. Randomized Controlled Tria
Page 148 and 149: of these individuals require more?
Page 150 and 151: 19 Lahtinen U, Rintala P, Malin A.
Page 152 and 153: SummarySummary | 151
Page 154 and 155: problems in both locomotor skills a
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Page 158 and 159: may be an indicator of activity lev
Page 160 and 161: SamenvattingSamenvatting | 159
Page 162 and 163: InleidingVoldoende bewegen en fithe
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Page 166 and 167: Hieruit bleek, dat de motivatie van
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Page 170 and 171: DankwoordDankwoord | 169
Page 172 and 173: De leden van de leescommissie, prof
Page 174 and 175: 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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