Feasibility, Test-Retest Reliability and Convergent Validity of the Two-Minute Step Test in Older Adults With Intellectual Disabilities.

To collect data on refractive errors and visual impairment in adults with an intellectual disability (ID) in the Netherlands. A randomized sample of 2100 participants was drawn from a base population of 9000 adults with intellectual disabilities in the Netherlands. This article reports on the first 900 participants. All participants underwent a protocol-based on-site ophthalmological assessment carried out by skilled investigators. Co-operation was classified according to the number of tests that could be carried out reliably and was good or excellent in 80% of subjects, average in 13% and poor in 7%. Refraction could be reliably assessed in 505/900 (56%) subjects. There was an increased risk of visual impairment in all subgroups compared to the general Dutch population. Visual acuity (VA) was related to the level of ID, but refractive errors were not. New spectacles were prescribed in 106 cases (12%). Of 374 people in whom both monocular VA and the refractive error of the right eye could be reliably assessed, 153 (41%) had a pretest prescription, 16 (10%) of which we found to be inadequate. Of the 221 participants without a pretest prescription, 41 (19%) benefited from correction. Only 38/84 (45%) subjects aged 50 years or older, who could benefit from correction for near vision, had near spectacles. New correction increased the mean distant VA significantly from 0.44 to 0.65 (p < 0.0005). With some adaptations, visual screening is feasible in a majority of adults with ID. Visual impairment and refractive errors are much more prevalent in adults with ID than in the normal population. Accurate spectacle correction resulted in significant improvement in distant VA.

Impact of high-intensity interval training on cardiorespiratory fitness, body composition, physical fitness, and metabolic parameters in older adults: A meta-analysis of randomized controlled trials.

Accessible summaryPeople with severe and profound intellectual disabilities need others to support them in most areas of their life. It can be difficult to communicate with people about change and transitions have been identified as an area of concern.As part of this research, we spent time with six adults with severe and profound intellectual disabilities. We talked to their families and professionals about their transitions and how they were involved in decisions that were made.Relationships people had with family members and key staff facilitated their engagement and experiences of the world.Our findings show that it is important that those who know the person well are closely involved in the planning of transitions. There should be a greater focus on maintaining the relationships that people have so that we can build bridges between settings and improve transitions for people with intellectual disabilities.AbstractBackgroundWithin the current literature, there is a focus on early transition experiences, such as people's school years, while adulthood remains a lesser researched chapter in the lives of people with intellectual disabilities. Furthermore, most studies focus on those with mild or moderate intellectual disabilities and people with severe or profound intellectual disabilities are often excluded from research.MethodsThis article explores the transition journeys of six adults with severe intellectual disabilities, including transitions from school to adult services and moving out of the family home. Data collection involved observations, document reviews and interviews with families and professionals in Scotland. Taking an ethics of care perspective, our focus was to explore in how far each person had people in their lives able to listen to them and if, in turn, those close to them were listened to during times of transition.FindingsOur findings demonstrate that transitions are complex processes that occur across different systems. Additionally, our findings emphasise the importance to consider relationships that are available to people within their adult lives when planning and supporting transitions. Combining interviews with observations helped us to see how the six adults showed agency and were communicating their preferences through the relationships they had with people within their immediate environment.ConclusionsThe need to reconceptualise participation from a relational and interdependent perspective is stressed to facilitate the involvement of people with severe intellectual disabilities within decision‐making processes.

Aims: Individuals with intellectual disabilities (ID) have a higher prevalence of psychiatric conditions, that can be linked to underlying genetic syndromes. Identifying these conditions early can enable tailored treatment, informed prognostic counselling, and improved long-term outcomes. There are established criteria for genetic testing in individuals with unexplained moderate, severe or profound ID. This audit aimed to assess the proportion of eligible patients under a Community Learning Disability Team’s psychiatry service who had genetic testing discussed, referred, or completed.Methods: A retrospective audit was conducted in a Community Learning Disability Community based in London. The electronic health records for all patients under the psychiatry caseload as of November 2024 were reviewed. Data extraction focused on the ID severity, details of genetic diagnoses and mention of clinical genetics testing within the notes. Specific search terms were used including “gene*”,” genome”, “congenital”, “test”, “investigation”, “diagnosis”, “karyotype”, “screen”, “chromosome”.Results: Of the 94 patients reviewed,1 had profound ID, 16 had a severe ID, and 22 had a moderate ID. Among these individuals, 20.5% had a confirmed genetic diagnosis, including conditions such as Trisomy 21, Costello syndrome, and inherited glycosylphosphatidylinositol deficiency. Mentions of genetic testing – such as prior referrals, discussions, or test results – were found in 25.6% of patients with moderate or severe ID. However, only one patient had been referred for genetic testing within this team, with others being referred whilst under Paediatrics or Child and Adolescent Learning Disability teams.Conclusion: This audit highlights a gap in the discussion and referrals for genetic testing within the Community Learning Disability team. Given the prevalence of genetic conditions in this population, and the potential impact on mental and physical health and management strategies, increasing awareness and embedding genetic testing discussions into routine psychiatric assessments is needed. Future steps include providing targeted education for the Learning Disability Team on the importance of clinical genetics, sharing the referral protocol to the local Clinical Genetics team, and considering the addition of a prompt in initial assessments to ensure genetic testing is routinely considered. These measures will enhance early identification, optimise treatment approaches, and improve long-term outcomes for individuals with ID and co-occurring mental illness.

Delayed heart rate recovery (HRR) after exercise, an indicator of cardiac autonomic nervous function (CANF), has been found to be associated with metabolic syndrome (MetS) in general populations. However, this relationship has not been extensively studied in older adults. The present study aimed to investigate the association between MetS and HRRs at 1, 2, 3 and 6minutes after exercise and cardiorespiratory fitness (CRF) in Chinese dwelling older adults. This retrospective, observational study consecutively enrolled participants aged 60 years or older who underwent physical examinations in Shenzhen District Yantian People's Hospital from September 2019 to July 2021. The participants were categorized into MetS and non-MetS groups according to the International Diabetes Federation criteria. Logistic regression analysis was applied to assess the association between MetS and CANF and CRF. Propensity score overlap weighting was used to adjust the covariates. A total of 987 eligible participants were included (mean age±SD, 66±4 years; male, 47.1%), of whom, 506 were diagnosed with MetS. MetS group showed significantly lower peak heart rate, HRR1-3, HRR6, peak metabolic equivalents, and peak oxygen consumption compared to the non-MetS group. Furthermore, peak systolic and diastolic blood pressures in the MetS group were significantly higher. Logistic regression analysis showed that MetS was significantly associated with HRR2, HRR3 (odds ratio [95% CI], 0.997 [0.995,0.999], both; P=0.009 and 0.005, respectively) and HRR6 (0.996 [0.994,0.998], P<0.001). The association between MetS and CRF was significant (0.98 [0.97,0.98], P<0.001). Elderly Chinese with MetS tend to exhibit reduced CANF and lower CRF. It is recommended that they boost physical activity and closely monitor heart rate and blood pressure during exercise to mitigate exercise-related risks.

Although physical fitness is relevant for well-being and health, knowledge on the feasibility of instruments to measure physical fitness in older adults with intellectual disability (ID) is lacking. As part of the study Healthy Ageing with Intellectual Disabilities with 1,050 older clients with ID in three Dutch care services, the feasibility of 8 physical fitness tests was expressed in completion rates: box and block test, response time test, Berg balance scale, walking speed, grip strength, 30-s chair stand, 10-m incremental shuttle walking test, and the extended modified back saver sit and reach test. All tests had moderate to good feasibility in all subgroups, except for the participants with profound ID (all tests), severe ID (response time test and Berg balance scale), and wheelchair users (all tests that involve the legs). We conclude that the 8 tests are feasible to measure physical fitness in most older adults with ID.

Objective: To evaluate the effects of aerobic, resistance, and combined training on cardiorespiratory fitness in healthy older adults, with a focus on improvements in maximal/peak oxygen uptake (VO2max/peak) and the 6-min walk distance (6-MWD).Methods: A systematic review and meta-analysis were conducted through July 2024, searching six databases: PubMed, CINAHL, Medline, Embase, Web of Science, and Scopus. Analyses were performed using Review Manager 5.3. Results: Fifty-one studies involving 3152 participants met the inclusion criteria. Exercise interventions significantly improved VO2max/peak (standardized mean difference (SMD): 0.51; 95% confidence interval (CI), 0.38 to 0.65; p < .001) and 6-MWD (MD: 36.18m; 95% CI, 26.52 to 45.84; p < .001) compared to control groups. Subgroup analyses showed consistent benefits across aerobic, resistance, and combined training modalities. Significant improvements were also observed across both medium-term (≤24 weeks) and long-term (>24 weeks) interventions, and in both male and female participants. Conclusion: Structured exercise interventions, regardless of type, are effective for improving cardiorespiratory fitness in older adults. The consistency of these effects across modalities, durations, and sexes underscores the adaptability and value of exercise as a central component of healthy aging strategies. Future research should aim to standardize intervention protocols and extend follow-up periods to clarify long-term outcomes and inform clinical guidelines.

BackgroundHigh-intensity interval training (HIT) can impact cardiorespiratory and muscular fitness simultaneously, yet protocols typically focus on lower-body exercise. For older adults however, performing activities of daily living requires upper- and lower-body fitness.AimsTo assess the effects of combined upper- and lower-body HIT on fitness in adults aged > 50 years.MethodsThirty-six adults (50–81 years; 21 male) were assigned via minimisation to either HIT (n = 18) or a no-exercise control group (CON, n = 18) following baseline assessment of leg extensor muscle power, handgrip strength, cardiorespiratory fitness (predicted VO2max) and health-related quality of life (HRQoL). The HIT group completed two training sessions per week for 12-weeks, performing a combination of upper-, lower- and full-body exercises using a novel hydraulic resistance ergometer. Data were analysed via ANCOVA with probabilistic inferences made about the clinical relevance of observed effects.ResultsAll participants completed the intervention with mean (82 ± 6%HRmax) and peak (89 ± 6%HRmax) exercise heart rates confirming a high-intensity training stimulus. Compared with CON, HIT showed possibly small beneficial effects for dominant leg power (10.5%; 90% confidence interval 2.4–19.4%), non-dominant leg power (9.4%; 3.3–16.0%) and non-dominant handgrip strength (6.3%; 1.2–11.5%) while the intervention effect was likely trivial (5.9%; 0.5–11.5%) for dominant handgrip strength. There was a likely small beneficial effect for predicted VO2max (8.4%; 1.8–15.4%) and small-moderate improvements across several domains of HRQoL.ConclusionCombined upper- and lower-body HIT has small clinically relevant beneficial effects on muscular and cardiorespiratory fitness in older adults.

What makes them feel like they do? Investigating the subjective well-being in people with severe and profound disabilities

Changes in white matter microstructure of the genu of the corpus callosum are predictive of cognitive decline in patients with mild cognitive impairment. Cardiorespiratory fitness (CRF) is positively associated with brain health; however, the relationship between cardiorespiratory fitness and white matter microstructure of the genu of the corpus callosum is unknown. Further, a novel diffusion method for assessing white matter microstructure, neurite orientation dispersion and density imaging (NODDI), can detect specific microstructural features that are not observed with conventional diffusion tensor imaging (DTI). Young (n=27, age=25±5, m=12, f=15) and older (n=23, age=64±5, m=12, f=11) adults free of underlying disease participated in this study. CRF was assessed using an incremental maximal exercise test on a cycle ergometer. On a separate visit, white matter microstructure of the genu of the corpus callosum was measured using both DTI and NODDI MRI scans. In young adults, there were no associations between CRF and white matter microstructure of the genu of the corpus callosum measured using either DTI or NODDI (p&gt;0.05). In older adults, there were no associations between CRF and white matter microstructure of the genu of the corpus callosum measured with DTI. However, in older adults, there was a positive association between CRF and orientation dispersion index of the genu of the corpus callosum measured with NODDI (r=0.47, p=0.02). In conclusion, using conventional DTI, no associations between CRF and white matter microstructure of the genu of the corpus callosum were observed. However, using NODDI, which can detect specific microstructural features, our results suggest that older adults with higher CRF demonstrated enhanced white matter microstructure, specifically orientation dispersion index, of the genu of the corpus callosum. Conventional DTI may underestimate the impact of CRF on age-related changes in white matter microstructure. National Institutes of Health - HL118154 (JNB), HL007936 (KBM). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Despite the wealth of research examining physical activity (PA) in children and adolescent without disability, there is a lack of research that has focussed on PA related to children and adolescents with intellectual disabilities (ID). The evidence that does exist in this area suggests that children and adolescents with ID are less active than their non-ID peers. The school environment offers numerous opportunities to engage in PA regularly, yet to date, school-based research focussing on PA in children and adolescents with ID is limited. Thus, the primary aim of this thesis was to investigate PA, sedentary time (ST) and playtime behaviours in children and adolescents with ID.Four study chapters are included in the thesis. Study 1 used uniaxial accelerometers to investigate habitual PA levels, sedentary behaviour and PA patterns in children and adolescents with severe and moderate ID. Results demonstrated that participants engaged in low amounts of PA, spent a large proportion of waking hours in ST and mainly engaged in short, sporadic bursts of PA.Study 2 investigated the PA levels of children and adolescents with severe and moderate ID during playtime and PE contexts using direct observation techniques. Participants engaged in similar levels of moderate to vigorous PA (MVPA), and spent minimal amounts of time engaging in sport based activities during playtime and PE. At playtime participants spent the majority of time playing alone or in small groups and no participants engaged in any large group play.Study 3 explored teachers’ perceptions of PA engagement for children and adolescents with ID. Teachers reported that pupils prefer to engage in fun, unstructured activities. Parents and teachers were identified as key role models who can influence PA engagement for this population and teacher participants explained that pupils with ID have limited understanding around PA and the benefits to health.Study 4 evaluated the effectiveness of a school-based PA intervention, delivered in two primary special educational needs (SEN) schools. The intervention demonstrated promising results, with an increase in accelerometer assessed MVPA levels between baseline and follow up of ~18mins. However, these findings were not statistically significant, possibly due to the small sample size involved. Minimum clinically important difference analysis suggested that changes in MVPA were likely to be beneficial to heath. Furthermore, qualitative data generated through teacher interviews highlighted positive intervention effects across the school.Overall the studies presented in this thesis provide an overview of PA engagement and associated behaviours in children and adolescents with ID. The major findings presented suggest that children and adolescents with moderate and severe ID are not sufficiently active, and the SEN school environment may be an important area to target PA interventions. The current thesis has made a significant contribution to our understanding related to the PA in children and adolescents with ID and has highlighted a number of recommendations for future research.

Walking programs alone or in combination with behavioral interventions have proven effective at improving quality of life among older adults with osteoarthritis (OA). It is unclear, however, whether the combination of both of these treatments is more effective at improving cardiorespiratory fitness in older adults with knee OA than a walking program alone or than unsupervised self-directed walking. In this study, we assessed cardiorespiratory fitness with 3 programs: a structured supervised community-based aerobic walking program with a behavioral intervention (WB; n = 41); a supervised program of walking only (W; n = 42); and an unsupervised self-directed walking program (n = 32). We measured maximal oxygen uptake (V̇O2peak), exercise test duration, and workload, heart rate, and ventilation at maximum aerobic capacity in older adults with knee OA after 6 months of WB, W, or self-directed walking. Overall, V̇O2peak improved by 4% in female walkers (+0.9 ± 2.5 mL O2·kg(-1)·min(-1); p < 0.001) and 5% in male walkers (+1.3 ± 2.7 mL O2·kg(-1)·min(-1); p < 0.001), and the change in fitness was similar with all 3 walking interventions. In conclusion, low- to moderate-intensity walking may improve and (or) prevent decrements in cardiorespiratory fitness in older adults with OA. This response was comparable in supervised walkers with and without a behavioral intervention and in unsupervised self-directed walkers.

Reliability and validity of the Japanese version of the Behavior Problem Inventory-Short Form

Reduced physical fitness is a cardiovascular disease (CVD) risk factor in the general population. However, generalising these results to older adults with intellectual disabilities (ID) may be inappropriate given their pre-existing low physical fitness levels and high prevalence of co-morbidities. Therefore, the aim of this study is to investigate the difference in physical fitness between older adults with ID with and without CVD. Baseline data of a cohort of older adults with borderline to profound ID (HA-ID study) were used (n=684; 61.6±8.2years; 51.3% male). CVD status (coronary artery disease, heart failure, stroke) was obtained from medical files. Cardiorespiratory fitness (10-m incremental shuttle walking test), comfortable and fast gait speed (over 5m distance) and grip strength (hand dynamometer) were measured. Multivariable linear regression models were used to investigate the association between these physical fitness components and the presence of CVD, adjusted for participant characteristics. Of the 684 participants 78 (11.4%) had CVD. Participants with CVD scored lower on cardiorespiratory fitness (-81.4m, P=0.002), comfortable gait speed (-0.3km/h, P=0.04) and fast gait speed (-1.1km/h, P=0.04). No significant differences were found for grip strength (-0.2kg, P=0.89). Older adults with CVD had significantly lower physical fitness levels than those without CVD, except for grip strength. Longitudinal research is needed to investigate causality.

CBCL in the assessment of psychopathology in Finnish children with intellectual disability