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Inspiratory Muscle Training and Physical Fitness in Children With Down Syndrome: A Randomized Controlled Trial

  • Mohamed Ali Elshafey
    Affiliations
    Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
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  • Reham Saeed Alsakhawi
    Correspondence
    Corresponding author: Reham Saeed Alsakhawi, PhD, Assistant Professor, Pediatrics Physical Therapy Department, Faculty of Physical Therapy, Cairo University, Egypt, Assistant Professor, Rehabilitation Sciences Department, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.
    Affiliations
    Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Cairo, Egypt

    Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
    Search for articles by this author

      Abstract

      Objective

      To investigate the effect of inspiratory muscle training (IMT) on physical fitness in children with Down syndrome (DS).

      Design

      Randomized control trial.

      Setting

      The study was conducted in a private physical therapy center.

      Participants

      Forty boys and girls with DS aged between 7 and 10 years were enrolled in this study (N=40). They were randomly and equally divided into 2 groups (A and B).

      Interventions

      All participants received 30 minutes of aerobic exercise training 3 times per week for 12 weeks, whereas group B received an additional 30 minutes of IMT before each aerobic exercise session.

      Main Outcomes Measures

      Physical fitness of the participants was assessed before and after the treatment using the 6-minute walk test (6MWT), Gio Digital Pressure Gauge, and Brockport Physical Fitness Test.

      Results

      This study measured maximal inspiratory pressure; maximal expiratory pressure; submaximal aerobic endurance using the 6MWT; and strength and endurance using the curl-up, dumbbell press, trunk lift, standing long jump, seated push-up, pull-up, flexed-arm hang, and back-saver sit and reach tests.

      Conclusions

      There was a significant improvement in the physical fitness of the children who underwent aerobic exercise. However, children who received IMT and aerobic exercise training demonstrated even more significant improvements in physical fitness than those who received aerobic exercise training only.

      Keywords

      List of abbreviations:

      BMI (body mass index), BPFT (Brockport Physical Fitness Test), DS (Down syndrome), IMT (inspiratory muscle training), MEP (maximal expiratory pressure), MIP (maximal inspiratory pressure), 6MWT (6-minute walk test)
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      References

        • Roizen NJ
        • Patterson D.
        Down's syndrome.
        Lancet. 2003; 361: 1281-1289
        • Irving C
        • Basu A
        • Richmond S
        • Burn J
        • Wren C.
        Twenty-year trends in prevalence and survival of Down syndrome.
        Eur J Hum Genet. 2008; 16: 1336-1340
        • Morris JK
        • Alberman E.
        Trends in Down's syndrome live births and antenatal diagnoses in England and Wales from 1989 to 2008: analysis of data from the National Down Syndrome Cytogenetic Register.
        BMJ. 2009; 339: b3794
        • Pitetti KH
        • Rimmer JH
        • Fernhall B.
        Physical fitness and adults with mental retardation. An overview of current research and future directions.
        Sports Med. 1993; 16: 23-56
        • Ram G
        • Chinen J
        Infections and immunodeficiency in Down syndrome.
        Clin Exp Immunol. 2011; 164: 9-16
        • Bull MJ.
        Pulmonary complications and chronic conditions of Down syndrome during childhood: an agenda for clinical care and research.
        J Pediatr. 2011; 158: 178-179
        • U.S. Department of Health and Human Services
        Physical activity and health: a report of the surgeon general.
        Centers for Disease Control and Prevention, Atlanta1996
        • Li C
        • Chen S
        • Meng How Y
        • Zhang AL
        Benefits of physical exercise intervention on fitness of individuals with Down syndrome: a systematic review of randomized-controlled trials.
        Int J Rehabil Res. 2013; 36: 187-195
        • Bouchard C
        • Shepherd R
        • Stephens T.
        Physical activity, fitness and health.
        Human Kinetics, Leeds1994
        • Temple VA
        • Frey GC
        • Stanish HI.
        Physical activity of adults with mental retardation: review and research needs.
        Am J Health Promot. 2006; 21: 2-12
        • Lloyd M
        • Burghardt A
        • Ulrich DA
        Angulo-Barroso R. Physical activity and walking onset in infants with Down syndrome.
        Adapt Phys Activ Q. 2010; 27: 1-16
        • Black DP
        • Smith BA
        • Wu J
        • Ulrich BD.
        Uncontrolled manifold analysis of segmental angle variability during walking: preadolescents with and without Down syndrome.
        Exp Brain Res. 2007; 183: 511-521
        • Shields N
        • Taylor NF
        • Dodd KJ.
        Effects of a community-based progressive resistance training program on muscle performance and physical function in adults with Down syndrome: a randomized controlled trial.
        Arch Phys Med Rehabil. 2008; 89: 1215-1220
        • Sutherland G
        • Couch MA
        • Iacono T.
        Health issues for adults with developmental disability.
        Res Dev Disabil. 2002; 23: 422-445
        • Lahtinen U
        • Rintala P
        • Malin A.
        Physical performance of individuals with intellectual disability: 30 year follow-up.
        Adapt Phys Activ Q. 2007; 24: 125-143
        • Verstegen RH
        • van Gameren-Oosterom HB
        • Fekkes M
        • Dusseldorp E
        • de Vries E
        • van Wouwe JP.
        Significant impact of recurrent respiratory tract infections in children with Down syndrome.
        Child Care Health Dev. 2013; 39: 801-809
      1. Kohl HW III, Cook HD. Educating the student body: taking physical activity and physical education to school. Kohl HW III, Cook HD, editors. Washington (DC): National Academy of Sciences; 2013. p 69.

        • Balic MG
        • Mateos EC
        • Blasco CG
        • Fernhall B.
        Physical fitness levels of physically active and sedentary adults with Down syndrome.
        Adapt Phys Activ Q. 2000; 17: 310-321
        • Tsimaras VK
        • Fotiadou EG.
        Effect of training on the muscle strength and dynamic balance ability of adults with down syndrome.
        J Strength Cond Res. 2004; 18: 343-347
        • Rimmer JH
        • Heller T
        • Wang E
        • Valerio I.
        Improvements in physical fitness in adults with Down syndrome.
        Am J Ment Retard. 2004; 109: 165-174
        • Carmeli E
        • Kessel S
        • Coleman R
        • Ayalon M.
        Effects of a treadmill walking program on muscle strength and balance in elderly people with Down syndrome.
        J Gerontol A Biol Sci Med Sci. 2002; 57: M106-M110
        • El Kafy EM
        • Helal OF.
        Effect of rowing on pulmonary functions in children with Down syndrome.
        Pediatr Phys Ther. 2014; 26: 437-445
        • Andriolo RB
        • El Dib RP
        • Ramos LR.
        Aerobic exercise training programmes for improving physical and psychosocial health in adults with Down syndrome.
        Cochrane Database Syst Rev. 2005; 3CD005176
        • Fernhall B
        • Pitetti KH
        • Rimmer JH
        • et al.
        Cardiorespiratory capacity of individuals with mental retardation including Down syndrome.
        Med Sci Sports Exerc. 1996; 28: 366-371
        • Khalili MA
        • Elkins MR.
        Aerobic exercise improves lung function in children with intellectual disability: a randomised trial.
        Aust J Physiother. 2009; 55: 171-175
        • Mendonca GV
        • Pereira FD.
        Influence of long-term exercise training on submaximal and peak aerobic capacity and locomotor economy in adult males with Down's syndrome.
        Med Sci Monit. 2009; 15: CR33-CR39
        • Xiao Y
        • Luo M
        • Wang J
        • Luo H.
        Inspiratory muscle training for the recovery of function after stroke.
        Cochrane Database Syst Rev. 2012; 5CD009360
        • Jung JH
        • Kim NS.
        The effect of progressive high-intensity inspiratory muscle training and fixed high-intensity inspiratory muscle training on the asymmetry of diaphragm thickness in stroke patients.
        J Phys Ther Sci. 2015; 27: 3267-3269
        • Sheel AW
        • Reid WD
        • Townson AF
        • Ayas NT
        • Konnyu KJ
        Spinal Cord Rehabilitation Evidence Research Team. Effects of exercise training and inspiratory muscle training in spinal cord injury: a systematic review.
        J Spinal Cord Med. 2008; 31: 500-508
        • Gosselink R
        • De Vos J
        • van den Heuvel SP
        • Segers J
        • Decramer M
        • Kwakkel G.
        Impact of inspiratory muscle training in patients with COPD: what is the evidence?.
        Eur Respir J. 2011; 37: 416-425
        • Lötters F
        • van Tol B
        • Kwakkel G
        • Gosselink R.
        Effects of controlled inspiratory muscle training in patients with COPD: a meta-analysis.
        Eur Respir J. 2002; 20: 570-576
        • Inzelberg R
        • Peleg N
        • Nisipeanu P
        • Magadle R
        • Carasso RL
        • Weiner P.
        Inspiratory muscle training and the perception of dyspnea in Parkinson's disease.
        Can J Neurol Sci. 2005; 32: 213-217
        • Fry DK
        • Pfalzer LA
        • Chokshi AR
        • Wagner MT
        • Jackson ES.
        Randomized control trial of effects of a 10-week inspiratory muscle training program on measures of pulmonary function in persons with multiple sclerosis.
        J Neurol Phys Ther. 2007; 31: 162-172
        • Enright SJ
        • Unnithan VB
        • Heward C
        • Withnall L
        • Davies DH.
        Effect of high-intensity inspiratory muscle training on lung volumes, diaphragm thickness, and exercise capacity in subjects who are healthy.
        Phys Ther. 2006; 86: 345-354
        • Britto RR
        • Rezende NR
        • Marinho KC
        • Torres JL
        • Parreira VF
        • Teixeira-Salmela LF.
        Inspiratory muscular training in chronic stroke survivors: a randomized controlled trial.
        Arch Phys Med Rehabil. 2011; 92: 184-190
        • Sutbeyaz ST
        • Koseoglu F
        • Inan L
        • Coskun O.
        Respiratory muscle training improves cardiopulmonary function and exercise tolerance in subjects with subacute stroke: a randomized controlled trial.
        Clin Rehabil. 2010; 24: 240-250
        • Lohman TG
        • Roche AF
        • Martorell R.
        Anthropometric standardization reference manual.
        Human Kinetics, Champaign1988
        • Li AM
        • Yin J
        • Yu CC
        • et al.
        The six-minute walk test in healthy children: reliability and validity.
        Eur Respir J. 2005; 25: 1057-1060
        • Casey AF
        • Wang X
        • Osterling K.
        Test-retest reliability of the 6-minute walk test in individuals with Down syndrome.
        Arch Phys Med Rehabil. 2012; 93: 2068-2074
        • Jalan NS
        • Daftari SS
        • Retharekar SS
        • Rairikar SA
        • Shyam AM
        • Sancheti PK.
        Intra- and inter-rater reliability of maximum inspiratory pressure measured using a portable capsule-sensing pressure gauge device in healthy adults.
        Can J Respir Ther. 2015; 51: 39-42
        • Caruso P
        • Albuquerque AL
        • Santana PV
        • et al.
        Diagnostic methods to assess inspiratory and expiratory muscle strength.
        J Bras Pneumol. 2015; 41: 110-123
        • DeMeulenaere S.
        Pulse oximetry: uses and limitations.
        J Nurse Pract. 2007; 3: 312-317
        • Winnick JP
        • Short FX.
        Conceptual framework for the Brockport Physical Fitness Test.
        Adapt Phys Activ Q. 2005; 22: 323-332
        • Winnick JP
        • Short FX.
        Brockport Physical Fitness Test manual-2nd edition with web resource: a health-related assessment for youngsters with disabilities.
        Human Kinetics Publishers, Canada2014
        • Gaowgzeh RM
        • Chevidikunnan MF
        • Khan FR.
        Impact of pulmonary rehabilitation program on respiratory function and exercise tolerance in subjects with Down syndrome.
        J Dent Med Sci. 2017; 16: 68-72
        • Ordonez FJ
        • Rosety MA
        • Camacho-Molina A
        • Fornieles G
        • Rosety M
        • Rosety-Rodrigues M.
        Aerobic training at moderate intensity reduces protein oxidation in adolescents with Down syndrome.
        Scand J Med Sci Sports. 2012; 22: 91-94
        • Değer U
        • Uzuner S
        • Tuzun EH
        • Eker L
        • Mihcioglu S
        • Malkoc M.
        Pulmonary functions, respiratory muscle strength and motor skills in children with down syndrome: a comparative study.
        Eur Respir J. 2017; 50: PA2566
        • Human A
        • Corten L
        • Jelsma J
        • Morrow B.
        Inspiratory muscle training for children and adolescents with neuromuscular diseases: a systematic review.
        Neuromuscul Disord. 2017; 27: 503-517
        • Mendonca GV
        • Pereira FD
        • Fernhall B.
        Reduced exercise capacity in persons with Down syndrome: cause, effect, and management.
        Ther Clin Risk Manag. 2010; 6: 601-610
        • Yang D
        • Park S
        • Kang J
        • Kim J
        • Kim S.
        Effects of inspiratory muscle exercise using biofeedback on inspiratory muscle activity and pulmonary function in patients with stroke.
        J Kor Phys Ther. 2015; 27: 287-291
        • Keles MN
        • Elbasana B
        • Apaydina U
        • Aribas Z
        • Bakirtas A
        • Kokturk N.
        Effects of inspiratory muscle training in children with cerebral palsy: a randomized controlled trial.
        Braz J Phys Ther. 2018; 22: 493-501
        • Farid R
        • Ebrahimi A
        • Khaledan A
        • Talaei-Khoei M.
        Effect of aerobic exercise training on pulmonary function and tolerance of activity in asthmatic patients.
        Iran J Allergy Asthma Immunol. 2005; 4: 133-138
        • Saudo E
        • Oliga E
        • Matsuse T
        • Teramoto S.
        The effects of pulmonary rehabilitation combined with inspiratory muscle training on pulmonary function and inspiratory muscle strength in elderly patients with chronic obstructive pulmonary disease.
        Nippn Ronen Igakkai Zasshi. 1997; 34: 929-934
        • Harver A
        • Mahler D
        • Baird C.
        Descriptors of breathlessness in healthy individuals.
        Chest. 2000; 118: 679-690
        • Tomohiro O
        • Yoshio N
        • Kiyoji T
        Effects of exercise intensity of physical fitness and risk factors for coronary heart disease.
        Obes Res. 2003; 11: 1131-1139
        • Sutbeyaz S
        • Koseoglu B
        • Gokkaya N.
        The combined effects of controlled breathing techniques and ventilatory and upper extremity muscle exercise on cardio-pulmonary responses in patients with spinal cord injury.
        Int J Rehabil Res. 2005; 28: 273-276
        • Emiel F.
        Approaches to improving health status in chronic obstructive pulmonary disease.
        Am Thorac Soc. 2006; 3: 262-269
        • Carmeli E
        • Barchad S
        • Lenger R
        • Coleman R.
        Muscle power, locomotor performance and flexibility in aging mentally-retarded adults with and without Down's syndrome.
        J Musculoskelet Neuronal Interact. 2002; 2: 457-462
        • Carmeli E
        • Kessel S
        • Bar-Chad S
        • Merrick J.
        A comparison between older persons with down syndrome and a control group: clinical characteristics, functional status and sensorimotor function.
        Downs Syndr Res Pract. 2004; 9: 17-24
        • Pitetti KH
        • Boneh S.
        Cardiovascular fitness as related to leg strength in adults with mental retardation.
        Med Sci Sports Exerc. 1995; 27: 423-428
        • Heller T
        • Hsieh K
        • Rimer J.
        Barriers and supports for exercise participation among adults with Down syndrome.
        J Gerontol Soc Work. 2002; 38: 161-178
        • Vicente-Rodriguez G
        • Ara I
        • Perez-Gomez J
        • Dorado C
        • Calbet JA
        Muscular development and physical activity as major determinants of femoral bone mass acquisition during growth.
        Br J Sports Med. 2005; 39: 611-616
        • Tylor NF
        • Dodd KJ
        • Shields N
        • Bruder A.
        Therapeutic exercise in physiotherapy practice is beneficial: a summary of systematic reviews 2002-2005.
        Aust J Physiother. 2007; 53: 7-16
        • Ajith S
        • D'Sa IP
        • Faisal CKM
        • Anandh V
        • Sreejith N
        Physiological Cost Index (PCI) in patients with chronic obstructive pulmonary disease (COPD) before and after giving two commonly used breathing exercises.
        Int J Curr Res Rev. 2011; 3: 41-48
        • Strasseles S
        • Smith D
        • Mahajan P.
        The costs of treating COPD in the United States.
        Chest. 2001; 119: 344-352
        • McConnell A.
        Respiratory muscle training e-book: theory and practice.
        Elsevier Health Sciences, 2013
        • Silva IS
        • Fregonezi GA
        • Dias FA
        • Ribeiro CT
        • Guerra RO
        • Ferreira GM.
        Inspiratory muscle training for asthma.
        Cochrane Database Syst Rev. 2013; 2013CD003792
        • Houston BW
        • Mills N
        • Solis-Moya A.
        Inspiratory muscle training for cystic fibrosis.
        Cochrane Database Syst Rev. John Wiley & Sons, Ltd. 2008; 4CD006112https://doi.org/10.1002/14651858.CD006112.pub2
        • Pollock RD
        • Rafferty GF
        • Moxham J
        • Kalra L.
        Respiratory muscle strength and training in stroke and neurology: a systematic review.
        Int J Stroke. 2013; 8: 124-130
        • Hodges P
        • Cresswell A
        • Thorstensson A.
        Preparatory trunk motion accompanies rapid upper limb movement.
        Exp Brain Res. 1999; 124: 69-79
        • Hodges PW
        • Gandevia SC.
        Changes in intra-abdominal pressure during postural and respiratory activation of the human diaphragm.
        J Appl Physiol. 2000; 89: 967-976
        • Kolar P
        • Sulc J
        • Kyncl M
        • et al.
        Stabilizing function of the diaphragm: dynamic MRI and synchronized spirometric assessment.
        J Appl Physiol. 2010; 109: 1064-1071
        • Hudson AL
        • Butler JE
        • Gandevia SC
        • De Troyer A.
        Role of the diaphragm in trunk rotation in humans.
        J Neurophysiol. 2011; 106: 1622-1628