Physical fitness of individuals with intellectual disability who have Special Olympics experience

Physical fitness of individuals with intellectual disability (ID) is low compared to those without ID. Part of the mis­ sion of Special Olympics is to develop physical fitness. However, little is known about fitness levels of Special Olympics athletes. This study examined the fitness level of individuals who participated in Nordic Special Olympics Games 2008 in Finland. The sample consisted of 59 Special Olympics athletes (44 men, 15 women, age 16–45) whose fitness scores were compared to INAS­athletes (International Association of Sport for para­athletes with ID) and Finnish non­athletic individuals with ID. The fitness battery consisted of 8 items: BMI, sit­and­reach test, stork stand, sit up, standing long jump, hand grip, shuttle run, and 1 mile/2 km walk test. BMI values were in the range of the nondisabled population. All other fitness values were below the means of the INAS­athletes, but above the Finnish non­athletes. Based on this data which is supported by the existing literature, the level of fitness of Special Olympics athletes needs further scrutiny. Given that the participants were Special Olympics athletes, who trained regularly, the low fitness level is alarming. Therefore, a closer examination of the contents of physical fitness training programs in Special Olympics is warranted.


Introduction
Physical fitness and regular physical activity are key factors in health and wellbeing of all individu als, including those with an intellectual disability (ID) (Lorentzen & Wikström, 2012).Physical fitness in most definitions includes the following compo nents: body composition, cardiorespiratory capacity, muscle strength and endurance, balance and flexibi lity.These components are essential for independent living and for developing functional skills (Cowley et al., 2010;Rimmer, 2000).
People with ID have sedentary lifestyles more often than people without disability.A sedentary lifestyle that results from inadequate levels of physical fitness can contribute to numerous health problems, including obesity, hypertension, low back pain, coro nary heart disease, osteoporosis, diabetes, and prema ture mortality (Evenhuis, Henderson, Beange, Len nox, & Chicoine, 2000;Foster, Walkley, & Temple, 2001).People have their own individual fitness needs, and physical fitness is as important for the adult with ID as it is for those without ID.However, the fitness levels of persons with ID are generally lower in com parison to general population (Graham & Reid, 2000;Lahtinen, Rintala, & Malin, 2007).Several predictors of lower physical activity in populations of individu als with ID compared to the general population have been identified: these include older age, immobility, seizure disorder, lack of opportunity to exercise during the day, living in congregate care, and bowel and blad der incontinence (Finlayson et al., 2009).Other factors that appear to mediate against participation include BMI (McGuire, Daly, & Smyth, 2007) and lack of choices and support for participation in daily phys ical activity (Messent, Cooke, & Long, 1998;Temple & Walkley, 2007).
Participation in regular physical activity is impor tant to maintain adequate fitness level, vocational productivity, and optimal health.Functional training regimes have produced significant results in children and adolescents as measured by various assessment measures from the Brockport Physical Fitness Test (Barwick et al., 2012).Individuals with ID need syste matic intervention strategies for building their physical fitness, but they are not always selfdirected enough to learn about the opportunities to engage in physical activity.
Moreover, motivation not only to initiate and but also to sustain training is often lacking.Generally speaking, the state of intervention research related to improved participation in physical activity by adults with ID is at best negligible, especially in light of sig nificant research with nonID adults (Brooker, van Dooren, McPherson, Lennox & Ware, 2015).

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www.eujapa.upol.czEUJAPA, vol. 9, no. 2, 2016 Rintala et al.Special Olympics provides yearround sports trai ning opportunities in many countries for children and adults with ID.As it relates to older Special Olym pians, Gillespie (2008) identified several significant areas of concern relative to participation patterns.He described a population of participants who were predominantly male, older than the typical partici pant from other sport organizations, and with fewer choices of sports.Regular participation in Special Olympics programs will affect their physical fitness levels and may help in their adjustment into manual job opportunities.
On the other hand, INAS (International Association of Sport for Paraathletes with an Intellectual Disa bility) provides competitive opportunities for high performance athletes with ID at the international level (Van de Vliet et al., 2006).INAS is an international charity and recognised by International Federation (IOSD) for athletes with an intellectual disability.It is a global organisation that promotes inclusion through sport and is a full member of the Internati onal Paralympic Committee representing intellectual disability.INAS was formed in 1986 and has grown to a membership of more than 80 nations across the world, representing more than 130,000 athletes with an intellectual disability (http://www.inas.org/aboutus/whoweare2/whoweare).To be able to par ticipate in every four year organized Global Games, the athletes must meet the established qualification or performance standards that involve intense training.Van de Vliet et al. (2006) examined the physical fitness profiles of elite athletes with ID who participa ted in the Global Games in 2004 and concluded that in general their fitness levels were, at best equal to, or lower than sporting peers without ID.Temple, Foley, and Lloyd (2014) examined data from the Special Olympics International Health Promotion database and concluded that over 56 percent of Special Olym pics participants, especially women and athletes from North America, were overweight and obese.
More specifically, Skowronski, Horvat, Nocera, Roswal, and Croce (2009) were able to delineate vari ation in physical and motor fitness across a range of ID from mild to severe using the Eurofit Special Test.Their results confirmed what has become the con sensus of research going back decades, that is to say, individuals with ID perform at lower levels than their nonID peers, females function at lower levels than males, and lower functioning is associated with decre asing level of ID.
The purpose of this study was to examine the level of physical fitness of those individuals who partici pated in Nordic Special Olympics competition 2008 in Finland.Secondly, their fitness level was compared to different values of available adult populations with ID.

Methods
Participants were 59 athletes (44 men, 15 women) of which 13 had Down syndrome.Data included 44 Finnish and 15 (25.4%)Swedish athletes who were all men.The mean age was 24.5 (ranging from 16-45).Demographics of the participants are found in Table 1.All participated in the Special Olympics Nordic Games in Finland 2008.They competed in dif ferent events such as athletics, swimming, football and floorball.
For comparison to Nordic Special Olympics athle tes (Nordic SO08), our data were compared to two different populations: 1. Global Games 2004 participants who were athletes with ID (INAS04).The mean age was 22.5 ± 5.25 (ranging from 17-49); 2. Sample of individuals (mean age 36.5, ranging from 34 to 39 years of age) with ID who did not participate in any regular physical activity from the study of Lahtinen et al. (2007) (Fin nish ID96).To investigate the physical fitness level of the partic ipants, the selected items from Eurofit for Adults (Oja & Tuxworth, 1995) were used.Earlier The Eurofit Test Battery has been found to be reliable with adolescent males with ID (MacDonncha, Watson, McSweeney, & O'Donovan, 1999).The anthropometric measure ments included weight and height.Body mass index (BMI) was defined as body mass (kg, measured using an electronic weighing scale to the nearest 0.1 kg) divided by height (m, measured to the nearest 0.1 cm) squared (kg/m 2 ).The fitness test battery included the following items: sitandreach, single leg balance, dynamic situp, standing long jump, hand grip, shuttle run and the 1 mile/UKK 2 km walk test.Flexibility was measured using the sit and reachtest.Participants sat on the floor with straight legs and reached forward as far as possible.The knees were held in extended posi tion by the investigator throughout the reach.The ruler had to be pushed on the bench with a smooth and slow movement.The better of the two trials was recorded to the nearest 1 cm.Whole body balance (stork stand, called leg balance) was measured as the number of tri als needed by individuals to achieve a total duration of 30 s in balance on their preferred foot on a flat firm surface wearing shoes.Abdominal muscle endurance was measured as the number of correctly completed situps in 30 s. Situps were performed with the hands placed at the side of the head, knees bent at 90 °, and the feet secured by the investigator.A full situp is defined as touching the knees with elbows and return ing the shoulders to the ground.Explosive strength was measured by a standing long jump, using a tape measure on a foam mat.Participants were asked to stand behind a line drawn perpendicular to the tape measure and jump forward as far as possible using arm swing and knee bending before jumping.The distance jumped was recorded from the takeoff line to the far thest point.The better of two trials was measured to the nearest 0.1 cm.Upper body strength was measured by hand grip dynamometer (Lafayette Instruments) to be squeezed as forcefully as possible with the pre ferred arm fully extended slightly away from the body, and palm facing inward.The better of two trials was recorded to the nearest 0.1 kg.Running speed was assessed using a 10 times 5 m shuttle run.Each par ticipant was required to sprint 10 times between two lines placed 5 m apart.The track was 1.3 m wide.The sprint was followed by immediately turning and running back.The result was recorded to the nearest tenth of a second.Cardiorespiratory endurance was estimated using a 2 km walk test (http://www.ukkinstituutti.fi/filebank/1118UKK_walk_test_testers_guide.pdf) from which the lap time of one mile (1609 m) and 2000 m was used for comparison.
All participants were invited to take part of the physical tests during the games.Members of the testing crew contacted the team leaders and coa ches personally at the competition sites to obtain a ran dom sample of the participants.Coaches accompanied the athletes to the testing.The testing did not interfere with any of the competitions.Informed consent was taken from each participant and/or their legal guardian before the testing began.The study was approved by the Special Olympics Finland.
Descriptive statistics were computed and statistical analyses were carried out using the Statistical Pack age for Social Science 20.0 (SPSS, Inc., Chicago, IL, USA).Nonparametric analysis (MannWhitney U) was used to calculate gender differences.For the com parison of mean values between groups, analysis of variance (ANOVA) and Tukey's HSD (honestly significant difference) test were used.All statisti cal tests with p values less than .05were considered significant.

Results
The test performance means and standard deviations of the Nordic Special Olympics athletes can be found in Table 2.The statistically significant differences between women and men were found in strength (long jump and hand grip), agility (shuttle run), and endu rance (1 mile/2 km walk), in favour of men.
INASathletes (both women and men) exceeded the Nordic Special Olympics athletes significantly in every physical fitness variable, except in flexibility (Table 3).In comparison to nonathletic individuals with ID, the Special Olympics athletes had lower BMI scores, were more flexible, had higher values in hand grip as well as walked faster one mile.The only statis tically significant difference was in hand grip, in favor of Special Olympics male athletes.On the other hand, the Special Olympics athletes' sit up scores were sta tistically significantly lower than those of non athletic individuals.It is noteworthy that the situp tests for Finnish individuals with ID had been performed without the time limit compared to the 30 s time limit for Special Olympics athletes.
their physical fitness.To our knowledge this has not been studied before.It was also interesting to com pare this population, with the similar age athletes who presumably train and compete at the higher level (INASathletes), and to individuals with ID who do not train and compete on the regular basis.It seemed that the BMI and flexibility values of Special Olympics athletes are very comparable to all the other populati ons.However, in most of the other fitness parameters which could be compared, Special Olympics athletes fell below the INASathletes.On the other hand, their fitness values exceeded the results of 'sedentary' indi viduals with ID, except in abdominal strength in which the testing procedure was different and did not allow the fair comparison.
Many studies state that individuals with ID have higher prevalence of overweight and obesity than their peers without ID (e.g., Rimmer & Yamaki, 2006).This applies to Special Olympics athletes as well (Foley, Lloyd, & Temple, 2013).Women with ID tend to be more overweight or obese than men (e.g., Temple et al., 2014).When compared to men, women seem to have higher BMI values than men also among nonathletes with ID (e.g., Lahtinen et al., 2007).In our study women and men did not differ statistica lly significantly from each other.Women's BMI was 26.8 which is considered overweight, but men's value was within the "normal" range.Although the number of women participating in this study was low (n = 15), this study does not support the earlier findings of high prevalence of obesity among individuals with ID.
In all of the fitness variables, men in this study overpowered women, except in flexibility and balance.Clear statistically significant difference was found in all other fitness variables except in situp results.Surprisingly, among INASathletes and Finnish seden tary ID's, men were better in balance than women (Lahtinen et al., 2007;Van de Vliet et al., 2006).In fle xibility test, female INASathletes as female Special Olympicsathletes scored better than males, but among sedentary individuals the situation was reversed.
INASathletes whose amount of training and moti vation to compete is presumably higher than among Special Olympics athletes, one would accordin gly expect the higher fitness performance.This was indeed the case, only in flexibility the difference was not found statistically significant, but still in favor of INASathletes.The study of Frey, McCubbin, Han niganDowns, Kasser and Skaggs (1999) supports this scenario, in the sense that when athletes whose goal is to compete in marathons, their peak VO 2 values are comparable to other seriously training athletes without disabilities.Unfortunately, we do not know the trai ning history of our sample nor do we know the events in which they most often compete.This is certainly a limitation of the study.
One would assume that Special Olympics athletes perform better than inactive individuals with ID.This was somewhat evidenced in our study, but the dif ference was not large.In fact, the only statistically significant difference was among men in hand grip strength and one mile walk time.Within women this difference was not detected.This will throw a sha dow on the amount of training that actually happens within Special Olympics programs.An interesting fin ding was that nonathletic Finnish individuals with ID scored better than the Special Olympics athletes but not better than INASathletes in abdominal strength.The difference was statistically significant, and the refore surprising in the light of previous literature.However, it could probably be explained by the fact that the situp tests for Finnish individuals with ID had been performed without the time limit which may have created the higher score than having a 30 s time limit of Special Olympics athletes.
As limitations of the study, we will find the following: First, overall the sample sizes were small among Special Olympics athletes and Finnish ID's, especially the number of women.Second, we did not know specifically the sport events of Special Olympics athletes participated in the games, and what they actually trained for.Third, the tests performed in the midst of the games environment may create extra anxiety, stress and fatigue for the athletes and, therefore, may affect their test performances negati vely.Fourth, the different number of individuals with Down syndrome within each group decreases the vali dity of the comparisons.Down syndrome (DS) is associated among other things with muscle hypotonicity, joint hypermobility, low cardiovascular fitness, and decreased muscle stren gth already in adolescence (GonzalezAguero et al., 2010).These characteristics will affect their fitness test scores negatively (Pitetti, Rimmer, & Fernhall, 1993).In our sample there were 13 Special Olympics athletes with DS (22% of the sample), 17 Finnish individuals with DS (26% of the sample), but none of the INAS athletes had DS.When comparing the fitness results among different groups, this puts INASathletes in the better position, and creates even the bigger dif ference in favor of INASathletes than it actually is.On the other hand, the similar percentage of DS indi viduals in the samples Special Olympics athletes and Finnish IDs makes the comparison meaningful.As Physical fitness of individuals with ID | 18 www.eujapa.upol.czEUJAPA, vol. 9, no. 2, 2016 an anecdotal observation, Special Olympics athletes with and without DS were compared.Athletes with DS performed poorer than nonDS athletes in almost all fitness variables, except in flexibility where they surprisingly were not better either.However, no stati stical difference was found between these two groups in situps and BMI.

Perspective
Nordic Special Olympic athletes' physical fitness level fell below the INASathletes, except in BMI and flexibility, but was better than those of Finnish nonathletes'.Based on the existing literature and the results of this study, the level of physical fitness of Special Olympic athletes is low and warrants more research.Moreover, the promotion of fitness and phys ical activity is essential to prolonging a healthy and robust lifestyle into one's later years -well beyond the time when competition has ended.Likewise, a clo ser examination of the contents of training programs offered in Special Olympics is defensible.Perhaps this level of scrutiny will justify additional training to reach and maintain moderate levels of physical perfor mance in all components of fitness across participants' lifespan.

Table 2
purpose of the study was to investigate at what level the Nordic Special Olympics athletes are with Test performances of Nordic Special Olympics athletes Note.M = mean; SD = standard deviation; p = statistical significance; 1 n = 12; 2 n = 37; 3 n = 47, 4 n = 49.

Table 3
Nordic athletes' test performances compared with reference populations