Physical exercise in people with down syndrome

This article's main objective is to analyze the importance of physical exercise in people with Down syndrome.

What is Down syndrome?

Down syndrome consists of a genetic alteration of the trisomy of chromosome 21 and is the most common cause of developmental delay (1).

Down syndrome involves intellectual disability, motor and physiological development problems and the health of the individual.

Normally these organic alterations occur during the development of the fetus, so the diagnosis can be made at birth (2).

As for the general population, life expectancy in people with down syndrome has increased.

In 1929 it was nine years, increased to 12 years in 1949, to 35 years in 1982, and has become 55 years and more today. This situation has led to an increase in health problems associated with age (16).

Young people with Down syndrome have levels of sedentary lifestyle that are even higher than those of young people in the general population, but data in adults are very scarce.

However, the physical and psychosocial profiles of a person with Down syndrome, as well as their living environment, their home and their degree of integration in the community can significantly influence their sedentary behavior (4).

The causes of death of people with down syndrome are related to poor physical performance, obesity, and acquired and inherited cardiovascular disorders (4).

Physiological and structural alterations in people with Down syndrome

Next we analyze the most common alterations in people with Down syndrome.

Obesity

People with Down syndrome have a much lower basal metabolic rate, which contributes to being overweight and obese.

In both children and adults the tendency to obesity is triggered by factors such as hypothyroidism and high levels of leptin. Around 46% of people with down syndrome do not participate in physical activities appropriate to their age (5).

Furthermore, obesity has been shown to be associated with an increase in inflammation mediators (pro-inflammatory cytokines and acute phase proteins) which, in turn, are related to the pathophysiology of multiple metabolic alterations, in addition to obesity (6 ).

Hypothyroidism

The most common thyroid dysfunction in down syndrome is hypothyroidism. It occurs between 20-28% of children with down syndrome and up to 40% of adults (9).

Among the symptoms associated with hypothyroidism, the following can be highlighted (10):

• Reduced motivation.
• Bradycardia

These symptoms determine, to a great extent, sedentary lifestyle in people with Down syndrome.

Untreated hypothyroidism can affect cognitive abilities and lead to a misdiagnosis of early Alzheimer's. Therefore, it is essential to monitor this risk periodically (4).

Cardiovascular system

Down syndrome is related to structural heart abnormalities. Between 46% and 17% of adolescents and adults suffer from mitral valve prolapse, even without previous heart disease.

For this reason, people with Down syndrome must have a cardiological evaluation prior to their participation in a physical exercise program (16).

Symptoms of mitral valve prolapse include fatigue, irritability, dyspnea, among others.

Adults with down syndrome have a lower cardiovascular capacity than their peers without down syndrome and consequently have a higher oxygen consumption, a higher ventilation per minute and a higher heart rate during physical exercise (17, 18) .

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Other characteristics of down syndrome that are associated with lower cardiovascular capacity are a low percentage of muscle mass, low strength, hypotonia, and a lower capacity for sympathetic response (heart rate and lactic acid) to exercise.

This causes a low adherence of people with Down syndrome to physical exercise (11).

Musculoskeletal disorders

At the musculoskeletal level, it is important to consider that people with Down syndrome have low muscle tone (hypotonia), hypermobility and hypermobility of the joints, characteristics that predispose them to joint dislocations and subluxations. In addition, they have poor articalure as a consequence of axial hypotonia and dorsal hyperkyphosis (16).

According to a recent study (12), one of the most common alterations in Down syndrome is flexible flat feet, which occurs in 91% of cases. Others that can occur, but with a lower incidence, are inflammatory arthritis (7%) and scoliosis (4.8%).

Atlantoaxial instability occurs in 17% of people with down syndrome, which occurs due to laxity between the first and second cervical vertebrae, and can lead to an atlantoaxial subluxation and, consequently, the risk of suffering from neurological injury.

Therefore, it is essential to evaluate whether or not this condition occurs before participating in activities that involve physical contact (13).

Osteoporosis

The probability of suffering from osteoporosis is higher in down syndrome. This is due to various factors, such as muscular hypotonia, low levels of physical activity, early menopause in women, decreased strength, and thyroid disorders (7).

There is lower bone mineral density in people with intellectual disabilities than in those unaffected.

Therefore, bone fragility and fractures associated with osteoporosis increase proportionally with age and with increasing life expectancy. In addition, there are studies that show that people with down syndrome have an increased risk of falls (8).

Benefits of physical exercise in people with down syndrome

Performing physical exercise can bring important benefits to people with Down syndrome, among which the following can be highlighted (14, 15, 16):

• Strength, balance and agility are increased, especially in the lower limbs.
• Improve heart rate.
• There is an optimization of bone mineral density.
• Increase muscle mass.
• In those physical-sports team activities, the sense of belonging to a group is favored.
• The ability to concentrate and memory is stimulated.
• Obesity and osteoporosis are prevented.
• It can lower blood pressure.
• Lowers LDL cholesterol levels and increases HDL cholesterol levels.
• Improves glucose tolerance.
• The risk of ischemic heart disease is reduced.

Type of physical exercise for people with down syndrome

At a general level, it is recommended for people with down syndrome to perform aerobic exercises (walking, jogging, swimming, riding a stationary bike, low-impact aerobics, etc.), with sessions lasting between 30 and 45 minutes being more effective. than sessions of 15 to 20 minutes (11).

The intensity should be between 60% -80% of the maximum heart rate, doing this type of physical exercise between 3 and 5 days a week.

All this under the supervision of professionals in physical activity and sport, carrying out a correct progression and individualization of the physical exercise that is proposed (16).

As for strength training, it is advisable to work it in a circuit form, which includes two-minute stations with 30-60 second breaks between stations, including exercises that involve the main muscle groups.

Exercises can be carried out with elastic bands, medicine balls, dumbbells or your own body weight (19).

Also, it is important to perform balance and proprioception exercises, as well as increase your NEAT through housework, gardening tasks or low intensity aerobic exercises (taking the stairs instead of taking the elevator, walking to do the shopping, etc. .) (fifteen).

conclusion

People with down syndrome suffer various alterations at a physiological and structural level that, in part, can be alleviated through correctly scheduled physical exercise.

This physical exercise has a positive impact on the physical and mental health of people with down syndrome, reducing the probability of the appearance of diseases related to sedentary lifestyle and, therefore, improving their quality of life.