Physical fitness in older people with ID—Concept and measuring instruments: A review
Introduction
Physical fitness describes how ‘fit’ a person physically is to cope with the demands set by his/her environment. For older adults to continue living independently, these demands include activities of daily life (ADL) and instrumental activities of daily life (IADL) (Bouchard & Shephard, 1994). ADL are activities necessary for self-care, like eating or bathing. IADL cover activities necessary for independent living, like cleaning, cooking or doing groceries (Rosen, Sorkin, Goldberg, Hagberg, & Katzel, 1998). These demands are not different for older people without or with intellectual disabilities. To execute these activities, and maintain living independently, a certain level of physical fitness is required (Bouchard and Shephard, 1994, Mahoney and Barthel, 1965). For people with physical fitness levels below this required level, it is often necessary to relocate to a care-facility.
The level of fitness declines with ageing (Bouchard et al., 1994, PAH, 1996). Primary ageing is the natural ageing process in the body itself, which decreases the physical fitness directly. Secondary ageing includes all changes influenced by the primary ageing process, such as age-related health conditions and lower activity levels. These changes further reduce physical fitness (Fleg et al., 2005).
Older adults with intellectual disabilities (ID) experience a similar primary and secondary ageing process as older adults without ID (Graham & Reid, 2000), but this group has some additional risk factors for low levels of physical fitness. Low levels of physical activity in younger adults with ID suggest a low level of physical fitness at a young age, probably at older age as well (Temple, Frey, & Stanish, 2006). Secondly, this group has high prevalences of sensory conditions and motor conditions, often leading to secondary arthritis, which influence physical fitness negatively (Evenhuis et al., 2001, van Schrojenstein Lantman-de Valk et al., 1997). With these differences in the secondary ageing process, older adults with ID are probably at an even higher risk of not meeting the physical demands set by the environment to live as independently as possible than older adults without ID. Because their intellectual disability already causes some degree of dependence on others, one could argue that the role of physical fitness in living as independently as possible, is even more important than in older people without ID.
Research of the last decade has shown that the secondary ageing process can be partly slowed down or reversed by physical activity (Buchman, Boyle, Wilson, Bienias, & Bennett, 2007), but more information about the actual physical fitness levels of older people with ID is necessary to apply this knowledge usefully to this group. However, to our best knowledge, there is no information available concerning reliable and feasible instruments to measure physical fitness in older adults with ID. The aim of this article was to propose a selection of instruments to measure physical fitness in older adults with ID which is functional, reliable and feasible, to create possibilities for widespread use and comparing, sharing and/or pooling of data.
First, we need to describe physical fitness for older people. In this paper, physical fitness is related to ADL and IADL, since these activities are a prerequisite for self-care and independent living.
Despite different opinions on the exact dimensions and components of the concept physical fitness, there is consensus about the multidimensional nature of physical fitness (Pate, 1988).
The American College of Sports Medicine uses the definition of physical fitness of the U.S. Centers for Disease Control and Prevention (ACSM, 2005): “Physical fitness is a set of attributes that people have or achieve that relates to the ability to perform physical activity.” Furthermore the U.S. Centers for Disease Control and Prevention offer a distinction between health-related components and athletic ability (or performance-related) components: “The health-related components are more important to public health than the athletic ability components” but “operational definitions of physical fitness vary with the interest and need of the investigators” (U.S. Centers for Disease Control and Prevention).
The health-related and performance-related components of physical fitness according to the U.S. Centers for Disease Control and Prevention are shown in Table 1.
For independent functioning, looking only at health-related components is too limited to describe physical fitness. Activities of daily life can be as much as a performance for one person as a sports match for another person. This is why performance-related components also play a role in independent functioning in older adults, although not all of the components mentioned in Table 1 are equally relevant. Speed is not necessary to perform activities of daily life, and neither is power (maximal strength output in one short interval). Balance encompasses a static and dynamic component and therefore agility (ability to turn quickly) as a separate component is less relevant. Thus, the operation of physical fitness of the U.S. Centers for Disease Control and Prevention is constructive, specific and measurable, but lacks any clustering of related components.
To achieve clustering of the remaining relevant components, Bouchard et al. (1994) provide a useful classification. According to these authors, health-related fitness refers to those components of fitness that are affected favorably or unfavorably by habitual physical activity and relate to health status (Bouchard & Shephard, 1994).
The authors defined it as “a state characterized by (a) an ability to perform daily activities with vigor and (b) demonstration of traits and capacities that are associated with a low risk of premature development of hypokinetic diseases and conditions” and presented a list of factors of health-related fitness, clustered in components (Table 2) (Pate, 1988). The components in this model are grouped at a different level than the components in the definition of the U.S. Centers for Disease Control and Prevention.
All mentioned components are distinguished theoretically, but are intertwined in their functioning practically. Morphological and metabolic components have an indirect influence on the execution of activities (Lemmink, 1996), they provide conditions in which activities can be performed. The muscular, motor and cardiorespiratory component have a crucial, active role in the actual execution of activities.
In Table 3, the remaining relevant components of physical fitness (health and performance related) from the model of the U.S. Centers of Disease Control and Prevention are combined with the components from Bouchard et al., to achieve a clustering in the components of the U.S. Centers of Disease Control and Prevention.
As said, the muscular, motor and cardiorespiratory component are crucial in the actual execution of activities, and therefore physical fitness of older people in this article is based on these three components according to Bouchard, operationalised in the seven components of the U.S. Centers of Disease Control and Prevention (third column in Table 3).
Section snippets
Literature search
A literature search in Pubmed, Embase and Web of Science was performed in April 2008 for all instruments used to measure any of the selected components of physical fitness (Table 3). The used search terms for the selected components are shown in Table 4. Muscular strength and muscular endurance are combined in one set of search terms and discussed together because they share the search term ‘muscular’ and therefore will result for a large part in the same selection of articles.
To identify which
Literature search
The literature search in the databases Pubmed, Web of Science and Embase generated 98 different instruments (Table 6). Google Scholar found two relevant reports of the European Network for Action on Ageing and Physical Activity: “European Report of an Expert Survey regarding Assessment Instruments on Physical Activity and Physical Functioning in Older People (Work Package 4)” (European report: Expert survey regarding Assessment Instruments on Physical Activity and Physical Functioning in Older
Conclusion
We have operationalised physical fitness for older adults with intellectual disabilities by the following components: coordination, reaction time, balance, muscle strength, muscle endurance, flexibility and cardiorespiratory endurance. To measure physical fitness in this population, we propose the following functional and feasible instruments with known psychometric properties, suitable for widespread use: Box and Block test, Reaction time test with an auditive and visual signal, Berg Balance
Discussion
In comparison to the total number of instruments, only a small number of instruments have been used in adults with ID or older adults without or with ID. This is not necessarily due to unsuitability of the other instruments, but more likely to the smaller amount of research that has been done in these populations. This is why the selection of instruments starts with all instruments found, not only those used in one of the specific populations.
The combination of ageing and having an intellectual
Financial disclosure
We certify that no party having a direct interest in the results of the research supporting this article has or will confer a benefit on us or on any organization with which we are associated AND, if applicable, we certify that all financial and material support for this research (e.g., NIH or NHS grants) and work are clearly identified in the title page of the manuscript.
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2020, Disability and Health JournalCitation Excerpt :Due to the conditions presented and the results obtained, this test is advisable for evaluating flexibility in people with ID. Although in the majority of studies the Sit and Reach test is used to assess the flexibility of the lower body,36 in the present work, the DTF was used because the technique involved seems to be simpler, as the participants do not have to keep their knees totally stretched during the test. In addition, as the test is done standing, the movement is more natural than the movement in the Sit and Reach test, since it is more frequent in a person’s daily activity (e.g., picking things up from the floor).
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☆ Sources of support: This study was carried out with the financial support of ZonMw (nr 57000003) and the participating care providers Abrona (Huis ter Heide), Amarant (Tilburg) and Ipse de Bruggen (Zwammerdam), all in the Netherlands.