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on this. To sum up, testing in persons with SPIMD in a feasible, valid and reliable way is possible,if participants are classified according to both GMFCS levels and level of disability, and if optimaltest environment and conditions are created.Adjusted FormulasThis thesis has brought forth a couple of important findings regarding formulas or equationsapplicable to research on this specific target group. First of all, it proposes a new reliable equationto calculate body height from tibia length [1]. Second, a simple prediction equation is suggestedfor predicting standing waist circumference from supine waist circumference measurement [2].The latter equation allows the comparison of supine measurements of waist circumference indisabled persons with international standards [9]. Third, we also found that the Fernhall’s formula[10, 11] for calculating peak heart rate for people with ID, systematically overestimates peak heartrate for people with SIMD [chapter 5]. The subheader “Functional exercise and aerobic capacity”discusses this finding in more detail.Overall, whereas for other specific target groups such as the elderly, children with cerebralpalsy, and persons with mild or moderate ID feasible and reliable fitness tests already wereavailable [5, 12, 13, 14, 15], the feasibility and reliability of physical fitness measurements and testsfor participants with SPIMD had so far not been established. Using the feasible and reliable fitnesstests described in this thesis, physical fitness levels can now be objectively evaluated. Moreover,specific interventions aimed at promoting physical fitness of participants with SPIMD can beevaluated objectively as well.Not only does this study thus contribute to existing literature, it also, quite practicallydelivers tools for the work floor. For instance, the fitness tests that were evaluated in chapters 2 to8 of this thesis have proven to be feasible, valid and reliable for persons with severe or profoundintellectual and multiple disabilities, and could thus immediately be implemented in daily practice.What follows is a more detailed overview of the results per studied fitness concept.Body compositionAnthropometric measurements are widely used to reliably quantify body composition and toestimate risk of overweight in both healthy subjects and patients. Body composition of personswith ID is described in several studies [16, 17, 18]. However, information about the reliability ofanthropometric measurements in persons with SIMD had so far not been subject to research. In45 participants with SIMD, body mass index, waist circumference, skinfolds, and tibia length weremeasured twice [1]. The results of this study show that for individuals with SIMD and GMFCS levelsI and II, feasibility and test-retest reliability for body composition measurements were acceptable,with exception of the skinfold measurements. Body Mass Index is calculated using body heightand body weight. However, body height is difficult to measure for those subjects unable to standupright. Therefore, a study was set up in order to calculate body height from tibia length. Thisstudy [1, chapter 2] revealed a new reliable equation to calculate body height from tibia length.Measuring tibia length is more feasible, accurate, and reliable than measuring the total bodyheight of participants with SIMD- both for those able to stand as for those not able to do so.Waist circumference as an indicator of abdominal fat is an important predictor of healthrisks and is usually measured in standing position. We found that measuring waist circumferencein participants with SIMD who are able to stand upright is feasible and reliable. However,Chapter 9 | 141
due to motor disabilities, many individuals with PIMD and GMFCS levels IV and V are unable tostand straight or to stand at all. When dealing with these participants, waist circumference canonly be measured with the participant lying in a supine position. It had so far been unknownwhether measuring waist circumference of a participant in a supine position is valid and reliable.This issue is particularly relevant when international standards [10] for healthy individualsare applied to the disabled. The results of a test-retest study [2, chapter 3] performed in 43participants with PIMD and GMFCS levels IV and V indicated that supine waist circumferencecan be reliably measured for this target group. Our validity study [2, chapter 3] performed in160 healthy participants, compared waist circumference obtained in both standing and supinepositions. This study shows that supine waist circumference is biased towards higher values (1.5cm) when compared with standing waist circumference. A simple equation could be put forward,which predicts standing waist circumference based on supine measurements. Such an equationallows for the comparison of waist circumference measurements of disabled persons with theinternational standards [10]. Based on BMI and waist circumference values, 10% of the femaleSPIMD subjects are obese and 39% are abdominal obese, while 0% of the male persons are obeseand only 7% are abdominal obese. Thus, women with SPIMD are at a higher risk for developingoverweight related health problems compared to SPIMD classified men. Compared to outcomesof measurements in persons with mild or moderate ID, persons with SPIMD show a more healthybody composition status [18, 19, 20]. Further research into the explaining mechanisms behind thisinteresting observation is recommended.Another issue related to body composition stems from the fact that children and adultswho have SPIMD and GMFCS level IV or V are often fed by stomach tube [21]. Tube feeding mayincrease body weight mainly through fat deposition [22]. Children and adults with severe CP haverelatively high body-fat/muscle-content ratio. When the relatively low energy expenditure is alsotaken into account, we see a potential risk of overfeeding [23]. To establish a healthy body weightin persons with PIMD, it is necessary to take into account both BMI and waist circumference.Rieken et al [24] suggest to use bioelectrical impedance analysis as an alternative measurementof body composition and present a preliminary clinical guideline on diagnosing undernutritionand overnutrition in children with severe neurological impairment and ID. We recommend thata similar guideline will be designed for adults with SPIMD and GMFCS levels IV and V, so as toprevent over- or undernutrution in this target group.Functional exercise and aerobic capacityCardiorespiratory fitness can be divided into functional exercise and aerobic capacity [35].Several tests are available for measuring functional exercise and aerobic capacity, including thesix-minute walking test (6 MWD) and the shuttle run test (SRT). However, it was unclear whetherthese tests are feasible and reliable when testing subjects with SIMD.Our studies [10, chapter 4] showed that the 6 MWD is feasible and reliable for testing participantswith SIMD and GMFCS levels I and II. An adapted SRT (aSRT) performed overground as well as ona treadmill has proven to be feasible and reliable for a target group with SIMD and GMFCS level I[chapters 4 and 5]. Moreover, the aSRT performed on a treadmill [chapter 5] appeared to be morevalid for determining peak heart rate than the aSRT performed overground for people with SIMDand GMFCS level I. We also found that the Fernhall’s formula [11] for calculating peak heart rateof subjects with ID systematically overestimates peak heart rate of subjects classified with SIMD.Thus,142 | Chapter 9
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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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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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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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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 126 and 127: 48 persons18 persons lacked permiss
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 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
Page 156 and 157: subjects are to be applied to perso
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
Page 164 and 165: verstandelijk niveau en bepaalde mo
Page 166 and 167: Hieruit bleek, dat de motivatie van
Page 168 and 169: Verder is duidelijk geworden dat me
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
Page 176 and 177: Dankwoord | 175
Page 178 and 179: Curriculum vitaeCurriculum vitae |
Page 180: Curriculum vitae | 179
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