Christopher C. Draheim

Prevalence of physical inactivity and recommended physical activity in community-based adults with mental retardation.

Little information has been reported on the leisure time physical activity (LTPA) habits of adults with mental retardation. Prevalence of physical inactivity and recommended LTPA of adults with mild to moderate mental retardation who live in community settings was described. Adults with mental retardation (76 men, 74 women) reported their physical activity habits. Overall, men and women who resided in community settings were similarly inactive, with 47% to 51% of individuals participating in little to no LTPA. Forty-two to 47% of them reported participation in moderate to vigorous LTPA five or more times per week. Limitations to quantifying physical activity through questionnaire process is discussed and development and implementation of programs designed to increase physical activity levels recommended.

Differences in Cardiovascular Disease Risk between Nondiabetic Adults with Mental Retardation with and without Down Syndrome.

A reduced expression of the insulin resistance syndrome, a common neuroendocrine disorder underlying atherosclerosis, may play a role in reduced atherosclerosis in adults with Down syndrome. We compared selected components of the insulin resistance syndrome between 75 adults with Down syndrome and 70 with mental retardation due to other causes. After adjusting for age differences, residence, cigarette smoking, and medication use, women with Down syndrome had lower fasting plasma glucose and lower systolic blood pressure than comparison women. Men with Down syndrome had lower systolic and diastolic blood pressure than comparison men. Results suggest that women with Down syndrome may be less likely to express the insulin resistance syndrome, and men and women with Down syndrome may possess fewer atherosclerotic risk factors than the comparison groups.

Physical Activity, Dietary Intake, and the Insulin Resistance Syndrome in Nondiabetic Adults With Mental Retardation

The association between physical activity, dietary behaviors, and elevated cardiovascular disease risk factor components of the insulin resistance syndrome in adults with mental retardation was identified. Established clinical cutoff points were used to identify 145 participants with mild mental retardation and hyperinsulinemia, borderline high triglycerides, low high-density lipoprotein cholesterol, hypertension, and abdominal obesity. Odds ratios were calculated from logistic regression analysis. Those who participated in more frequent bouts of physical activity or who consumed lower dietary fat intakes were approximately one third as likely to have hyperinsulinemia and abdominal obesity compared to those who participated in less frequent physical activity or who consumed higher fat intakes, suggesting that these behaviors are protective against elevated components of the insulin resistance syndrome.

Dietary intake of adults with mental retardation who reside in community settings.

The dietary intake of adults with mental retardation among three different community residential settings was described and compared. Two dietary screeners were administered to 325 adults. The womens Fruit and Vegetable Screener scores from group homes were significantly higher than scores from those with family members and in semi-independent settings. No significant differences were found in dietary intake across residences for men. Overall, 0% to 6% of the participants consumed the recommended 5 or more fruits and vegetables per day, and 15% to 30% consumed the recommended<or=30% or less of calories from fat. Results suggest that regardless of residential setting, men and women do not consume enough fruits and vegetables and consume too much dietary fat.

Walking Habits of Adults With Mental Retardation

The walking activity of men and women with mental retardation residing in community settings was described. Participants were 38 women (M age=.7, SD=9.5) and 65 men (M age=35.9, SD=11.2). They wore pedometers for 7 days. A 2 x 2 factorial ANOVA indicated no significant gender differences in total step counts or between participants with and those without Down syndrome. A post-hoc analysis revealed that participants walked less on Saturday than during the weekdays. Only 21.1% of the women and 21.5% of the men with mental retardation accumulated the recommended 10,000 steps per day.

Comparison of Intima-Media Thickness of the Carotid Artery and Cardiovascular Disease Risk Factors in Adults With Versus Without the Down Syndrome

Adults with Down syndrome (DS) residing in large institutional settings possess low levels of atherosclerosis. The purpose of this study was to determine whether community-residing adults with DS possess less atherosclerosis than adults without DS. The second purpose was to examine the relation between cardiovascular disease risk factors and intima-media thickness (IMT), a measure of atherosclerosis, in patients with DS. B-mode images of the left common carotid artery were collected to assess IMT in 52 adults with DS and age-, gender-, and race-matched adults without DS (27 women, 25 men; mean age 42 ± 5 years). Total body fat, blood pressure, fasting lipid profiles, insulin, glucose, C-reactive protein, homocysteine, physical activity, and dietary intake were also assessed. Adults with DS possessed lower IMT (0.43 ± 0.07 vs 0.48 ± 0.09 mm, p <0.001), systolic blood pressure (116 ± 15 vs 125 ± 17 mm Hg, p <0.011), and diastolic blood pressure (59 ± 10 vs 73 ± 9 mm Hg, p <0.001) and higher C-reactive protein (0.58 ± 0.55 vs 0.30 ± 0.42 mg/dl, p <0.003), triglycerides (126.5 ± 55.2 vs 103.8 ± 53.2 mg/dl, p <0.048), and total body fat (37.8 ± 10.2% vs 32.4 ± 11.2%, p <0.002) than controls. Male gender (p <0.001) and physical activity (p = 0.020) were identified as predictors of IMT for adults with DS and fasting insulin (p <0.001), age (p <0.001), gender (p <0.001), fruit and vegetable intake (p = 0.001), low-density lipoprotein cholesterol (p = 0.004), and smoking (p = 0.023) for controls. In conclusion, community residing adults with DS may be protected against atherosclerosis despite elevated total body fat and elevated cardiovascular disease risk factors. Predictors of IMT differed for patients with DS compared to controls, which indicates that patients with DS possess a unique model of atherogenesis.

Validity of a modified aerobic fitness test for adults with mental retardation.

PURPOSE The purpose of this study was to determine whether further modifications to the Rockport Fitness Walking Test (RFWT) protocol produces similar results to the previously modified protocol (Rintala et al., 1992) used for adults with mental retardation (MR). A second purpose of this study was to evaluate prediction equations developed to estimate aerobic capacity from the 1:5RFWT. METHODS In an effort to make the RFWT more efficient for testing adults with MR the one pacer to one walker protocol (1:1RFWT) was further modified to one pacer to five walkers (1:5RFWT). Ten healthy men and 13 women (21.7 +/- 2.6 yr) with MR (IQ = 42-68) performed graded maximal treadmill tests, one 1:1RFWT and two 1:5RFWT. RESULTS The end times (P = 0.326) and end heart rates (P = 0.457) did not significantly differ between the 1:1RFWT, the first 1:5RFWT, and the second 1:5RFWT. Separate Bland and Altman plots indicated that both end time and end heart rate had good agreement between protocols and also had good repeatability between the two 1:5RFWT. The main predictor variable, end time, from the 1:1RFWT and the 1:5RFWT was highly (and similarly) associated with the measured aerobic capacity (VO2peak), indicating a high predictive value for the 1:5RFWT end time. Bland and Altman plots of predicted and measured VO2peak for the prediction equations of Kline et al. (1987) and Rintala et al. (1987) indicated a general overestimation of measured values. CONCLUSIONS The 1:5RFWT provides similar end times and end heart rates as the 1:1RFWT along with similar associations of end times to measured VO2peak. The 1:5RFWT could be used to predict aerobic capacity; unfortunately, the present prediction equations overpredict VO2peak for adults with MR and need to be revised.

Bone Mineral Density in Adults With Down Syndrome, Intellectual Disability, and Nondisabled Adults

Individuals with intellectual disability (ID) or Down syndrome (DS) may be at greater risk of osteoporosis. The purpose of this study was to compare bone mineral density (BMD) of DS, ID, and non-intellectually disabled (NID) populations. In each group, 33 participants between the ages of 28 and 60 years were compared. BMD was measured with dual-energy x-ray absorptiometry (DXA) scans. BMD (p < .0001) between all groups was significantly different. Participants with DS had significantly lower BMD compared to NID participants. Individuals with ID had significantly lower BMD compared to NID subjects. Participants with DS had the lowest BMD of all groups. DS subjects display a greater risk for osteoporosis than ID subjects or control populations.