1. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 14 Resistance-Training Strategies for Individuals with Intellectual Disabilities

2. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Developmental Disabilities Mental retardation Cerebral palsy Autism Spina bifida Vision or hearing impairment Other delays

3. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Mental Retardation (MR) Intellectual and developmental disorder Characterized by substandard intelligence quotient (IQ) and need of support Most common developmental disorder in industrialized society

4. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. MR Previous classification system based on IQ scores: –Mild –Moderate –Severe –Profound

5. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. New Classification System by AAIDD American Association on Intellectual and Developmental Disabilities (AAIDD) Defines MR as being manifested by significantly subaverage intellectual functioning

6. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. New Classification System by AAIDD Exists concurrently with related limitations in two or more adaptive skills areas Must be evident before age 18

7. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Individuals with Disabilities Education Act (IDEA) Adds schooling to other criteria for MR Individuals with MR usually have IQ below 70 –Plus several deficits in adaptive skills

8. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Two Classification Levels of MR Mild and severe Classification based on: –How well individual functions in adaptive skill areas –Level of support required due to deficit More support required, less functional the individual

9. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Four Levels of Support 1.Intermittent –Support on as-needed basis –Either high or low intensity 2.Limited –Support needed consistently over time –Lesser intensity

10. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Four Levels of Support 3.Extensive –Regular support 4.Pervasive –Constant care

11. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Prevalence of MR In industrialized society, 3 percent of total population Approximately 9 million in US More than 90 percent of all individuals with MR classified as mild

12. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Prevalence of MR Less than 10 percent of all individuals with MR classified as severe Severe MR –IQ levels below 50 Often below 35

13. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Economic Impact of MR Most live either independently, with family, in group homes, or in assisted living facilities De-institutionalization movement in progress for last 30 to 40 years Most fully/partially integrated in society

14. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Mortality Rates One and one-half to four times higher than average population Linked to: –Low IQ –Poor self-care skills –Physical inactivity

15. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Mortality Rates Most common medical problems include cardiovascular and pulmonary disorders –Except Down syndrome (DS) More susceptible to infections, leukemia, and early onset Alzheimer’s disease

16. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Etiology of MR Specific cause usually unknown Leading cause: –Fetal alcohol syndrome Second leading cause: –Maternal drug abuse

17. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Etiology of MR Other causes: –Birth-related trauma –Infectious diseases –Maternal disorders –Genetic disorders –Chromosomal abnormalities E.g., DS

18. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Other Causes of MR Poverty Malnutrition Infections during pregnancy –E.g., rubella, herpes Severe stimulus deprivation

19. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Other Causes of MR Perinatal factors –E.g., prematurity Postnatal factors –E.g., lead poisoning

20. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. DS Most common manifestation of MR Occurs in approximately 1 per 800 to 1 per 1000 births Risks increase with maternal age

21. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Physical Characteristics of DS Short stature Short arms and legs Foot and toe malformations Visual impairments Joint laxity related to atlanto-axial instability

22. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Physical Characteristics of DS Skeletal muscle hypotonia Pulmonary hypoplasia Congenital heart disease Reduced immune function Higher risks for developing leukemia and Alzheimer’s disease

23. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Benefits of Resistance Training Likely plays important role in developing and maintaining independent living Increases muscle strength Increases quality of life, independence, and (potentially) vocational productivity

24. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Comparative Levels of Muscle Strength Individuals with MR have very low levels of strength –30 to 50 percent lower than nondisabled peers Individuals with DS have even lower levels of strength –30 to 40 percent lower than MR peers –Less than 50 percent of nondisabled peers

25. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Comparative Levels of Muscle Strength Persistent problem from childhood into adulthood Even very active MR individuals still 25 percent below normal strength values Few existing studies have found lower body strength to be low

26. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Leg and Back Strength from Childhood to Early Adulthood

27. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Implications of Low Muscle Strength Limits recreational activities Limits vocational productivity Hinders aerobic capacity and endurance

28. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Research Supports Resistance Training Improvements shown in muscle endurance Beneficial effects reflect type of training conducted Self-motivated individuals with mild MR can maintain strength gains independently

29. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Research Supports Resistance Training For individuals with DS, studies show changes in strength with variety of training approaches Refer to Table 14.1

30. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Program Design Considerations Level of understanding Attention span Level of fitness –Prior exercise experience Age

31. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Program Design Considerations Potential physical impairments –Significant coordination problems Individualization of program Reason for program –Individual’s goals Medications

32. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Health Screening Includes: –Cardiovascular disease –Diabetes –Cancer –Lung disease –Infectious diseases

33. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Health Screening Includes: –Neurological conditions –Orthopedic conditions –Medications –Exercise and lifestyle history

34. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Exercise Testing Considerations Conduct thorough health history screening Involve parent/guardian Screen individuals with DS for: –Congenital heart and related conditions –Atlanto-axial instability –Lax ligaments

35. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Exercise Testing Considerations Obtain physician clearance when individual has serious medical complication Include familiarization process to increase individual’s comfort level and understanding of process –Ongoing Use weight machines for testing

36. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Exercise Testing Considerations Use either standard 1 RM testing protocols or submaximal loads estimating 1 RM Perform 10- to 12-repetition set to fatigue Fatigue may be hard to ascertain –Repeat test, as needed Test eight to 12 exercises using major muscle groups

37. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Program Components Ensure individual can perform exercise using proper form Teach proper breathing techniques to avoid Valsalva maneuver Teach lower weights during two- to three- week initial period at intensity of 40 to 50 percent of 1 RM

38. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Program Components Begin with warm-up of five to seven minutes Follow with “easy” set –E.g., 40 to 50 percent of 1 RM Follow with normal set Include flexibility training before/after

39. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Program Components After first few weeks, follow ACSM guidelines for resistance training programs for healthy adults Re-test frequently Gauge signs of muscular fatigue to assess intensity

40. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Program Components Exercises should stress all major muscle groups Modify exercises based on individual’s physical limitations –Refer to Table 14.2 Spotting required See sample 24-Week Program