Purpose/ Hypothesis: Youth with Down Syndrome (DS) have limited participation in physical activity. When compared to their typically developing peers, adults with DS display decreased functional mobility and strength. Exercise has shown to improve the physical fitness, overall health, and quality of life in people with DS. The Lee Silverman Voice Treatment (LSVT® BIG) is an effective treatment approach designed for patients with Parkinson’s disease. The core components of LSVT® BIG include large amplitude movements, sensory calibration, high intensity, and maximum effort while performing the daily exercises. Due to hypotonicity associated with DS, these individuals typically display kyphotic posture, shortened step length and overall lower amplitude movements. The LSVT® BIG protocol has the potential to improve muscle tone and overall fitness in adults with DS similar to the improvements seen in the Parkinson’s disease population, but the effects have yet to be studied. The purpose of this pilot study was to test the feasibility of implementing a 4 week standardized group exercise program in adults with DS, and assess whether subjects improved after this protocol.
Number of Subjects: A convenience sample of 8 adults with DS were recruited from a residential facility.
Materials/Methods: This exploratory, feasibility pilot study employed a pretest-posttest design. Outcome measures were assessed at baseline and at one week post intervention. The independent variable for this study was the LSVT® BIG standardized exercise protocol. Outcome measures included: the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB) and timed single leg stance (SLS) for balance, the 10 meter walk test (10MWT) for gait speed, the 30 second sit-to-stand test for lower extremity functional strength, and the timed-up-and-go (TUG) for overall functional mobility. Each participant completed the established LSVT® BIG protocol in a group exercise format, totaling 16 sessions.
Results: LSVT® BIG certified instructors were able to lead the group exercises for all 8 adults with DS with no adverse effects. Attendance varied between 10 to 16 sessions, with an average participation rate of 13.75 days (SD = 2.17). Standard LSVT® BIG modifications were easy to implement when needed. There was a statistically significant increase in self-selected gait speed (median self-selected gait speed post-test score, Mdn = 1.01, vs. median pre-test score, Mdn = 0.78, z = 35, p = 0.02). There were no other significant changes in functional strength, balance or fast gait speed, however the median scores improved for all dependent variables except for one of the mCTSIB scores and 30 second sit-to-stand test.
Conclusions: A 4 week high-amplitude standardized exercise program can improve self-selected gait speed in adults with DS, but may not have a statistically significant effect on their balance or functional strength.
Clinical Relevance: The LSVT® BIG standardized exercise protocol can be used for adults with DS in a group exercise setting and may also improve the gait speed for this population.
Flores, Megan; Barta, Kristen; Sneary, Martha; Ferreira, Germaine; and Ardolino, Elizabeth, "Feasibility and Preliminary Outcomes of a Standardized Exercise Program in Adults with Down Syndrome: A Pilot Study" (2018). Physical Therapy Collection. 7.