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Open Access 01-06-2012 | Original article

Adults with Down syndrome have reduced cardiac response after light exercise testing

Authors: J. C. Vis, H. A. C. M. De Bruin-Bon, B. J. Bouma, S. A. Huisman, L. Imschoot, K. van den Brink, B. J. M. Mulder

Published in: Netherlands Heart Journal | Issue 6/2012

Abstract

Objective

Physical fitness is reduced in adults with Down syndrome (DS). The present study was conducted to elucidate the exercise response in adults with DS.

Design

Case controlled before-after trial.

Setting

Residential centre for people with intellectual disabilities.

Participants

96 Adults with DS, 25 non-DS adults with an intellectual disability, 33 controls.

Interventions

Echocardiography to exclude heart defects and to measure cardiac index (CI) in the supine position, supine position with raised legs, and following ten knee bends.

Main outcome measure

Exercise testing

Results

At rest, mean CI was not significantly different between persons with DS and controls (2.3 vs. 2.4 l/min/m², p = 0.3). However, mean CI after exercise was significantly lower in DS (2.9 vs. 3.7 l/min/m², p < 0.001) and mean CI increase from rest to exercise was more than 50% lower in DS. On the contrary, CI after exercise was similar among controls and non-DS adults with an intellectual disability. Significantly lower stroke volumes in DS were found with insufficient heart rate response.

Conclusions

CI at rest was similar in adults with DS and controls; however persons with DS have a diminished cardiac response to exercise. Stroke volumes were significantly lower in DS during exercise and a compensated heightened heart rate was absent.

Bittles AH, Bower C, Hussain R, et al. The four ages of Down syndrome. Eur J Publ Health. 2007;17:221–5.CrossRef

de Graaf G, Vis JC, Haverman M, et al Assessment of prevalence of persons with Down syndrome: a theory-based demographic model. JARID 2010

Finesilver C. A new age for childhood diseases. Down syndrome. RN. 2002;65:43–8.PubMed

Glasson EJ, Sullivan SG, Hussain R, et al. The changing survival profile of people with Down’s syndrome: implications for genetic counselling. Clin Genet. 2002;62:390–3.PubMedCrossRef

Duffels MG, Vis JC, van Loon RL, et al. Down patients with Eisenmenger syndrome: is bosentan treatment an option? Int J Cardiol. 2009;134:378–83.PubMedCrossRef

Duffels MG, Vis JC, van Loon RL, et al. Effect of bosentan on exercise capacity and quality of life in adults with pulmonary arterial hypertension associated with congenital heart disease with and without Down’s syndrome. Am J Cardiol. 2009;103:1309–15.PubMedCrossRef

Barnhart RC, Connolly B. Aging and Down syndrome: implications for physical therapy. Phys Ther. 2007;87:1399–406.PubMedCrossRef

Bell AJ, Bhate MS. Prevalence of overweight and obesity in Down’s syndrome and other mentally handicapped adults living in the community. J Intel Disabil Res. 1992;36(Pt 4):359–64.

Prasher VP, Filer A. Behavioural disturbance in people with Down’s syndrome and dementia. J Intel Disabil Res. 1995;39(Pt 5):432–6.CrossRef

10.

Shamas-Ud-Din S. Genetics of Down’s syndrome and Alzheimer’s disease. Br J Psychiatry. 2002;181:167–8.PubMed

11.

Vis JC, Duffels MG, Winter MM, et al. Down syndrome: a cardiovascular perspective. J Intellect Disabil Res. 2009;53:419–25.PubMedCrossRef

12.

Gonzalez-Aguero A, Vicente-Rodriguez G, Moreno LA et al. Health-related physical fitness in children and adolescents with Down syndrome and response to training. Scand J Med Sci Sports 2010

13.

Fernhall B, Pitetti KH, Rimmer JH, et al. Cardiorespiratory capacity of individuals with mental retardation including Down syndrome. Med Sci Sports Exerc. 1996;28:366–71.PubMed

14.

Fernhall B, McCubbin JA, Pitetti KH, et al. Prediction of maximal heart rate in individuals with mental retardation. Med Sci Sports Exerc. 2001;33:1655–60.PubMedCrossRef

15.

Baynard T, Pitetti KH, Guerra M, et al. Age-related changes in aerobic capacity in individuals with mental retardation: a 20-yr review. Med Sci Sports Exerc. 2008;40:1984–9.PubMedCrossRef

16.

Baynard T, Pitetti KH, Guerra M, et al. Heart rate variability at rest and during exercise in persons with Down syndrome. Arch Phys Med Rehabil. 2004;85:1285–90.PubMedCrossRef

17.

Guerra M, Llorens N, Fernhall B. Chronotropic incompetence in persons with Down syndrome. Arch Phys Med Rehabil. 2003;84:1604–8.PubMedCrossRef

18.

Fernhall B, Baynard T, Collier SR, et al. Catecholamine response to maximal exercise in persons with Down syndrome. Am J Cardiol. 2009;103:724–6.PubMedCrossRef

19.

Millar AL, Fernhall B, Burkett LN. Effects of aerobic training in adolescents with Down syndrome. Med Sci Sports Exerc. 1993;25:270–4.PubMed

20.

Varela AM, Sardinha LB, Pitetti KH. Effects of an aerobic rowing training regimen in young adults with Down syndrome. Am J Ment Retard. 2001;106:135–44.PubMedCrossRef

21.

Tsimaras V, Giagazoglou P, Fotiadou E, et al. Jog-walk training in cardiorespiratory fitness of adults with Down syndrome. Percept Mot Skills. 2003;96:1239–51.PubMed

22.

Schiller NB, Shah PM, Crawford M, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989;2:358–67.PubMed

23.

Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18:1440–63.PubMedCrossRef

24.

Vis JC, de Bruin-Bon RH, Bouma BJ et al. ‘The sedentary heart’: physical inactivity is associated with cardiac atrophy in adults with an intellectual disability. Int J Cardiol. 2011.

25.

Figueroa A, Collier SR, Baynard T, et al. Impaired vagal modulation of heart rate in individuals with Down syndrome. Clin Auton Res. 2005;15:45–50.PubMedCrossRef

26.

Pitetti KH, Climstein M, Campbell KD, et al. The cardiovascular capacities of adults with Down syndrome: a comparative study. Med Sci Sports Exerc. 1992;24:13–9.PubMed

Title: Adults with Down syndrome have reduced cardiac response after light exercise testing
Authors: J. C. Vis
H. A. C. M. De Bruin-Bon
B. J. Bouma
S. A. Huisman
L. Imschoot
K. van den Brink
B. J. M. Mulder
Publication date: 01-06-2012
Publisher: Bohn Stafleu van Loghum
Published in: Netherlands Heart Journal / Issue 6/2012
Print ISSN: 1568-5888
Electronic ISSN: 1876-6250
DOI: https://doi.org/10.1007/s12471-012-0254-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Adults with Down syndrome have reduced cardiac response after light exercise testing

Abstract

Objective

Design

Setting

Participants

Interventions

Main outcome measure

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design

Setting

Participants

Interventions

Main outcome measure

Results

Conclusions

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