Reported gum disease as a cardiovascular risk factor in adults with intellectual disabilities.

BACKGROUND: Several risk factors for cardiovascular disease (CVD) have been identified among adults with intellectual disabilities (ID). Periodontitis has been reported to increase the risk of developing a CVD in the general population. Given that individuals with ID have been reported to have a higher prevalence of poor oral health than the general population, the purpose of this study was to determine whether adults with ID with informant reported gum disease present greater reported CVD than those who do not have reported gum disease and whether gum disease can be considered a risk factor for CVD. METHODS: Using baseline data from the Longitudinal Health and Intellectual Disability Study from which informant survey data were collected, 128 participants with reported gum disease and 1252 subjects without reported gum disease were identified. A series of univariate logistic regressions was conducted to identify potential confounding factors for a multiple logistic regression. RESULTS: The series of univariate logistic regressions identified age, Down syndrome, hypercholesterolemia, hypertension, reported gum disease, daily consumption of fruits and vegetables and the addition of table salt as significant risk factors for reported CVD. When the significant factors from the univariate logistic regression were included in the multiple logistic analysis, reported gum disease remained as an independent risk factor for reported CVD after adjusting for the remaining risk factors. Compared with the adults with ID without reported gum disease, adults in the gum disease group demonstrated a significantly higher prevalence of reported CVD (19.5% vs. 9.7%; P = .001). CONCLUSION: After controlling for other risk factors, reported gum disease among adults with ID may be associated with a higher risk of CVD. However, further research that also includes clinical indices of periodontal disease and CVD for this population is needed to determine if there is a causal relationship between gum disease and CVD.

Obesity and associated factors in adults with intellectual disability.

BACKGROUND: We examined the prevalence of obesity in adults with intellectual disabilities (ID) compared with the general population, and the factors associated with obesity and weight management status, comparing individuals with ID who were overweight or obese to those who were not. METHODS: We analysed baseline data (n = 1450) from the ongoing 4-year Longitudinal Health and Intellectual Disabilities Study (LHIDS) using a multivariate approach. Measures included body mass index (BMI), demographics, level of ID, diagnoses related to ID, health behaviours (i.e. physical activity, dietary habits, smoking, and alcohol consumption), various health parameters (e.g. mobility limitation, medications), and residential type and location. RESULTS: Compared with the general population, adults (≥ 18 years) with ID had a higher prevalence of obesity (38.3% vs. 28%) and morbid obesity (7.4% vs. 4.2%). Being female (AOR = 1.40, 95% CI = 1.09-1.81), having Down syndrome (AOR = 2.53, 95% CI = 1.86-3.45), taking medications that cause weight gain (AOR = 1.80, 95% CI = 1.38-2.37), engaging in less moderate physical activity (AOR = 0.89, 95% CI = 0.79-0.99), and drinking greater amounts of soda (AOR = 1.20, 95% CI = 1.02-1.42) were associated with higher rates of obesity. CONCLUSION: Adults with ID, in general, have a high risk of developing obesity, and women with ID have a high risk of developing morbid obesity. Health promotion initiatives should target individuals with the greatest risk.

Obesity and obesity-related secondary conditions in adolescents with intellectual/developmental disabilities.

BACKGROUND: To explore the prevalence of obesity and related secondary conditions associated with obesity in adolescents with intellectual/developmental disabilities (IDD). METHODS: In total, 461 parents of adolescents with IDD (M = 14.9 year, SD = 1.9) across 49 US states completed a web-based survey containing questions related to their child's health status, including body weight and existing health conditions. Results were compared with published data for youth without disabilities. RESULTS: Adolescents with autism and Down syndrome were two to three times more likely to be obese than adolescents in the general population. Secondary health conditions were higher in obese adolescents with IDD compared with healthy weight adolescents with IDD including high blood pressure, high blood cholesterol, diabetes, depression, fatigue, liver or gallbladder problems, low self-esteem, preoccupation with weight, early maturation and pressure sores. CONCLUSION: Obesity is as much of a health problem in youth with IDD as it is among youth without disabilities and, in certain disability groups, is a significantly greater health problem. Obese youth with IDD have a high number of obesity-related secondary conditions predisposing them to greater health problems as they transition into adulthood. Federal and local initiatives to reduce obesity among youth in the general population must recognise the need for interventions that are also relevant (i.e. accessible and effective) for youth with IDD.

Prediction of maximal heart rate in individuals with mental retardation.

PURPOSE: It is well known that individuals with mental retardation (MR), especially those with Down syndrome (DS), have low maximal heart rates (MHR). We evaluated the ability to predict MHR in individuals with MR and DS in comparison with persons without MR. METHODS: Subjects completed a maximal exercise test on the treadmill with metabolic and HR measurements. Stepwise multiple regression was used to develop prediction equations for subjects with MR (N = 276; 97 with DS) and without (N = 296) MR, ranging in age from 9-46 yr. RESULTS: Subjects with MR exhibited significantly lower MHR (177 vs 185 beats.min(-1)) and VO2peak (33.8 vs 35.6 mL.kg-1.min(-1)). In subjects with MR, age was a poor predictor of MHR, Y = 189 - 0.59 (age) (R = 0.30, SEE = 13.8 beats.min-1; P < 0.01), but age was a better predictor for subjects without MR, Y = 205 - 0.64 (age) (R = 0.52, SEE = 9.9 beats.min(-1); P < 0.01). A large sample Z test indicated that these regression coefficients were significantly different (P < 0.01). However, adding DS to the regression improved the prediction for subjects with MR, Y = 210 - (0.56 age) - (15.5 DS) (R = 0.57; SEE = 11.8 beats.min(-1), P < 0.01). CONCLUSION: MHR can be predicted with similar accuracy in subjects with and without MR, provided DS is accounted for in the equation for the subjects with MR.

A new measure for assessing the physical activity behaviors of persons with disabilities and chronic health conditions: the Physical Activity and Disability Survey.

PURPOSE: Assess the psychometric properties of the Physical Activity and Disability Survey (PADS), a new physical activity measure for persons with disabilities and chronic health conditions. DESIGN: Cross-sectional and pre-post designs were employed. SETTING: A Midwestern university fitness center. SUBJECTS: Participants were 103 individuals with disabilities and/or chronic health conditions. MEASURES: The Physical Activity and Disability Survey (PADS), peak oxygen uptake (peak VO2), maximum workload (MW), and time to exhaustion (TE) during exercise. RESULTS: Factor analysis revealed a four-factor model that generally corresponded to PADS subscales. Cronbach alpha coefficients ranged from .67 (Exercise) to .77 (Time Indoors). Test-retest reliability (1-week interval) ranged from .78 (Time Indoors) to .95 (Leisure Time Physical Activity). Interrater reliability ranged from .92 (Household Activities) to .99 (Exercise, Leisure Time Physical Activity, Total Activity). Significant (p < .05) correlations were found between PADS subscales and absolute peak VO2 (Leisure Time Physical Activity, Household Activity, Total Activity), relative peak VO2 (Exercise, Time Indoors), MW (Time Indoors, Household Activity), and TE (Household Activity, Total Activity). Analyses of variance revealed that, unlike controls, health promotion program participants evidenced significant pre-post gains as measured by the Exercise subscale and Total Activity score. CONCLUSIONS: The findings lend support for the reliability and validity of the PADS as a measure of physical activity of groups who are sedentary and disabled.

Exercise training in a predominantly African-American group of stroke survivors.

PURPOSE: The purpose of this study was to determine the effects of a 12-wk exercise training program in a predominantly African-American group of stroke survivors with multiple comorbidities. METHODS: A lag-control group design was employed to provide training to all participants (N = 35). Two 12-wk training iterations were arranged. Participants trained 3 d x wk(-1) for 60 min x d(-1) (cardiovascular, 30 min; strength, 20 min; flexibility, 10 min). Outcome measures included peak VO2 (mL x min(-1), mL x kg(-1) x min(-1), maximal workload (MW), time to exhaustion (TTE), 10 RM on two LifeFitness strength machines, grip strength (GS), body weight (BW), total skinfolds (TS), waist to hip ratio (WHR), hamstring/low back flexibility (HLBF), and shoulder flexibility (SF). RESULTS: Compared with controls, the exercise group showed significant gains in peak VO2 (P < 0.01), strength (P < 0.01), HLBF (P < 0.01), and body composition (BW and BMI, P < 0.05; TS, P < 0.01). There was no significant difference between exercise and controls on WHR, SF, and GS. DISCUSSION: A supervised exercise training program for stroke survivors with multiple comorbidities was highly effective in improving overall fitness, potentially reducing the risk of further disease and disability. Greater effort must be made on the part of the public health community to increase access to community-based physical activity programs for persons with stroke.

Effects of a short-term health promotion intervention for a predominantly African-American group of stroke survivors.

BACKGROUND: The study examined the effects of a 12-week health promotion intervention for a predominantly urban African-American population of stroke survivors. DESIGN: A pre-test/post-test lag control group design was employed. PARTICIPANTS/SETTING: Participants were 35 stroke survivors (9 male, 26 female) recruited from local area hospitals and clinics. MAIN OUTCOME MEASURES: Biomedical, fitness, nutritional, and psychosocial measures were employed to assess program outcomes. RESULTS: Treatment group made significant gains over lag controls in the following areas: (1) reduced total cholesterol, (2) reduced weight, (3) increased cardiovascular fitness, (4) increased strength, (5) increased flexibility, (6) increased life satisfaction and ability to manage self-care needs, and (7) decreased social isolation. CONCLUSION: A short-term health promotion intervention for predominantly African-American stroke survivors was effective in improving several physiological and psychological health outcomes.

Barriers to exercise in African American women with physical disabilities.

OBJECTIVE: To examine what factors African American women with one or more physical disabilities perceive as barriers to exercise and how they rank them. SETTING: Department of Disability and Human Development at a major university. STUDY DESIGN: Data were collected through telephone interview using a newly developed instrument (Barriers to Physical Exercise and Disability [B-PED]) that addressed issues related to physical activity and the subjects' disability. SUBJECTS: Fifty subjects were asked questions about their participation and interest in structured exercise. RESULTS: The four major barriers were cost of the exercise program (84.2%), lack of energy (65.8%), transportation (60.5%), and not knowing where to exercise (57.9%). Barriers commonly reported in nondisabled persons (eg, lack of time, boredom, too lazy) were not observed in our sample. Only 11% of the subjects reported that they were not interested in starting an exercise program. The majority of subjects (81.5%) wanted to join an exercise program but were restricted by the barriers reported. CONCLUSION: African American women with a physical disability are interested in becoming more active but are limited in doing so because of their inability to overcome several barriers to increased physical activity participation.

Health promotion for people with disabilities: the emerging paradigm shift from disability prevention to prevention of secondary conditions.

The premise of this article is that, until recently, health promotion for people with disabilities has been a neglected area of interest on the part of the general health community. Today, researchers, funding agencies, and health care providers and consumers are leading an effort to establish higher-quality health care for the millions of Americans with disabilities. The aims of a health promotion program for people with disabilities are to reduce secondary conditions (eg, obesity, hypertension, pressure sores), to maintain functional independence, to provide an opportunity for leisure and enjoyment, and to enhance the overall quality of life by reducing environmental barriers to good health. A greater emphasis must be placed on community-based health promotion initiatives for people with disabilities in order to achieve these objectives.

Physical activity patterns of African-American women with physical disabilities.

UNLABELLED: There is a dearth of research on the exercise and activity patterns of persons with disabilities, particularly minority women with disabilities. This lack of information makes it difficult for public health officials to set policy guidelines for this segment of the population. PURPOSE: The purpose of this study was to survey the exercise and activity patterns of African-American women with severe physical disabilities (N = 50). METHODS: The Physical Activity and Disability Survey (PADS) was created for subjects who have a severe limitation in movement and function (e.g., limited ability to stand or walk, needs an assistive aid to ambulate, needs assistance with activities of daily living). Reliability data were obtained on the PADS for interrater, test-retest, and internal consistency on the two subscales (Exercise and Activity). The Exercise subscale had an interrater reliability of 0.83 and test/retest reliability of 0.85. The Activity subscale had an interrater reliability of 0.68 and test/retest reliability of 0.66. Cronbach's alpha for internal consistency was 0.78 for the Exercise subscale and 0.68 for the Activity subscale. RESULTS: Results showed very low levels of exercise and general activity patterns in African-American women with physical disabilities. Only 8.2% of the sample participated in leisure-time physical activity, and only 10% engaged in aerobic exercise three or more days per week for at least 15 min. Unstructured physical activity (e.g., work-related activity, housework, gardening, shopping) was nearly absent. CONCLUSION: Our data suggest that the extremely low levels of self-reported physical activity in African-American women with severe physical disabilities expose them to a higher risk of secondary health conditions.

Overweight prevalence in persons with Down syndrome.

Prevalence of overweight among the general population has been reported to be 33% for males and 36% for females. We undertook this study to establish overweight prevalence data in a cohort with Down syndrome and to stratify the incidence of overweight by living arrangement. We measured Body Mass Index (BMI) in 283 persons with Down syndrome and found a higher prevalence of overweight in this group compared to the general population. Individuals with Down syndrome living in a family setting had a higher incidence of overweight than did those living in a group home setting. Overweight prevalence among persons with Down syndrome should be considered a major public health concern that warrants further attention from researchers, practitioners, family members, and individuals with Down syndrome.

Effects of an aerobic activity program on the cholesterol levels of adolescents.

The purpose of this study was to determine the effects of a 15-week aerobic activity program on the total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) levels of 25 high school students, ages 14-17 years (experimental group = 14, control group = 11). Participants in the activity program exercised 4 days per week in a specially designed physical education class, while the control group participated in the regular physical education program. Results of the analysis of covariance found significant reductions in TC in the training group (control group Adj M = 190.2 mg/dl, experimental group Adj M = 173.1 mg/dl, p < .05), but no significant changes in HDL-C (control group Adj M = 49.8 mg/dl, experimental group Adj M = 50 mg/dl). While the exercise program appeared to have a beneficial effect on TC in 12 of 14 participants (86%), HDL-C also dropped in 12 of 14 participants (86%).

Research on physical activity and disability: an emerging national priority.

Despite the voluminous amount of research that has been published in the field of exercise science over the past three decades, there remains a paucity of information on the activity patterns and physiological responses to exercise in persons with disabilities. In an era when physical activity has grown to new heights in terms of its importance in promoting health and preventing disease, many questions pertaining to how it affects the lives of individuals with physical disabilities remain unanswered. The purpose of this paper is to review the prevalence of disability in the United States and to present recommendations for future research on physical activity and disability. A related objective of this paper is to encourage exercise scientists to undertake research on this increasingly significant group of American citizens.

Cardiorespiratory capacity of individuals with mental retardation including Down syndrome.

This study evaluated the cardiorespiratory capacity of persons with MR with and without Down syndrome. Analyses of individual data records of maximal exercise tests with metabolic analyses were conducted on tests of 111 subjects (31 men and 16 women with DS; 35 men and 29 women without DS) from six participating centers. All centers used a walking treadmill protocol previously shown to produce valid and reliable maximal tests with this population. Peak oxygen uptake and peak minute ventilation were higher in men than in women (P < 0.006), and in subjects without DS (P < 0.006). Peak heart rate was also higher in subjects without DS (P < 0.006). Peak respiratory exchange ratio (RER) was higher in subjects without DS (P < 0.006). Using peak RER as a covariate did not change the results. An analysis of peak minute ventilation, heart rate and VO2 of subjects with a peak RER above 1.1 revealed the same results. These data show that individuals with mental retardation have low levels of peak VO2, consistent with low levels of cardiovascular fitness. Individuals with Down syndrome have even lower levels of peak VO2 than their peers without Down syndrome, a finding that is possibly mitigated by the lower peak heart rates of the individuals with Down syndrome.

Health characteristics and behaviors of adults with mental retardation residing in three living arrangements.

Three hundred and twenty-nine subjects (aged 17-70 years) residing in an institution (N = 184), group home (N = 39), or with one or more family members (N = 106) were evaluated on body composition, blood lipids, and health behaviors. Subjects in the institutional group had lower body weights than those in the group home and natural family settings (p < .001) and also had lower BMIs and percent body fat levels compared to those in the natural family (p < .001). The institutional group also had lower total cholesterol and LDL-C levels than the group home and natural family groups (p < .001) and lower TG and ratio of total cholesterol to HDL-C than the natural family group (p < .01). Although overall use was quite limited, residents in the group home setting smoked more cigarettes, drank more alcohol and coffee, and exercised less than those in the institution and natural family (p < .001). Group home residents also exercised less. Health promotion and disease prevention initiatives for persons with mental retardation living in group homes, in supported living placements, and with their natural families should be undertaken and carefully evaluated.

Comparison of body composition between German and American adults with mental retardation.

Several studies have confirmed that there is a high incidence of obesity among adults with mental retardation (MR) living in the United States. However, there has never been a systematic comparison of the anthropometric characteristics between adults with MR from different countries. The purpose of this study was to compare the body composition levels of 210 adults with MR residing in two different residential settings in the United States and in Germany. Subjects' mean age was 31.7 yr. Skinfold measurements were used to estimate percent body fat (PBF), and height and weight were used to compute body mass index (BMI). Results indicated that PBF was significantly higher among females (P < 0.001); subjects in the institutional setting had significantly lower PBF and BMI levels than subjects in the family setting (P < 0.001); and PBF and BMI levels were significantly higher in subjects from the United States compared with the German subjects (P < 0.001). These findings indicate a need for further investigation into the caloric intake, energy expenditure, lifestyle, and metabolic characteristics of adults with MR living in the United States and Germany.

Validation of the Rockport Fitness Walking Test for adults with mental retardation.

This study determined if the generalized equations created for the Rockport Fitness Walking Test were a valid estimation of cardiorespiratory fitness for adults with mental retardation (MR). Subjects included 25 males and females (mean age = 33.3 +/- 7.4 yr) with MR. A maximal treadmill test was administered (mean VO2peak = 29.5 +/- 7.2 ml.kg-1 x min-1; 2.2 +/- 0.62 l.min-1). Subjects' age, weight, sex, walk time, and immediate post-HR were used in the generalized equations for predicting VO2peak (mean VO2peak = 36.5 +/- 7.6 ml.kg-1 x min-1 and 2.7 +/- 0.66 l.min-1). Significant correlations (P < 0.01) were obtained between the measured and predicted peak VO2 levels. However, significant and consistent differences were also observed between the measured and predicted VO2peak values (P < 0.02). Only 28% (l.min-1) and 36% (ml.kg-1 x min-1) of the subjects' measured VO2peak fell within the prespecified value of the predicted VO2peak, thus indicating that the prediction equations overestimated the VO2peak and cardiovascular fitness levels of adults with MR.

Cardiovascular risk factor levels in adults with mental retardation.

Cardiovascular risk factors in a population of adults with mental retardation were examined. The subjects resided in three types of settings (16+ bed facility, group home, and natural family) and were measured on the following parameters: blood lipids, obesity, and smoking. The data were compared to a nonretarded population and to the guidelines established by the National Cholesterol Education Program. Results indicated that adults with mental retardation had cardiovascular risk profiles similar to those of individuals without mental retardation in the Framingham Offspring Study and that to the extent that cardiovascular health is a concern to the general population, it must also be a concern for individuals with mental retardation.