Effects Of Swimming On Physical Growth In Adolescents With Down Syndrome

Abstract

The rate and extent of growth are influenced by many genetic and non-genetic factors such as: heredity, gender, genetic disorders and, respectively, nutrition, physical activity, disease, lifestyle, social, cultural and emotional environments etc. Children with Down syndrome, a genetic disorder, also grow and develop, but such processes take place more slowly and show a number of special peculiarities. Somatic growth can be emphasised by means of anthropometric assessment, on which our research relies. Our initiative assessed a number of selected parameters specific for auxological anthropometry, designed to evaluate the growth status of three adolescents with trisomy 21: two boys and one girl aged 12 years. The research was conducted for a period of one year, during which the three adolescents involved were subjected to a full intervention programme that also included sporting activity, namely swimming classes. The final test highlighted that our subjects’ height has increased (especially the lower limb length) and their posture during current activity has improved. Moreover, somatic improvements occurred due to the aerobic effort specific for the conducted swimming classes, and these improvements were also reflected by functional parameters like thoracic mobility or chest expansion, which has developed. All those gains have potentiated the health condition of adolescents with Down syndrome and, through the high wellness level obtained, have positively influenced their daily life.

Keywords: Down syndromeadolescentsgrowthanthropometric measurementsswimming

Introduction

Growth and development of the human body are processes that start since the conception and continue postpartum, throughout infancy, childhood, adolescence and early adulthood, when they stop.

Growth and development do not take place uniformly, the periods with slower rhythm being followed by periods with faster rhythm of growth. The rate and extent of growth are influenced by two groups of factors: genetic factors (they set the limits of grows – heredity, gender, genetic disorders including trisomy 21) and numerous non-genetic factors or environmental factors which modulate those limits (nutrition, physical activity, illness and disease, lifestyle, social, cultural and emotional factors etc. (Gallahue & Cleland-Donnelly, 1993; Cameron & Bogin, 2002).

Problem Statement

Growth is a quantitative process of cell multiplication materialised by an increase in body weight, volume and dimension, referred to as “quantitative accumulation and augmentation” (Ionescu, 2013, p. 242). Development is a qualitative process of cell differentiation that implies functional changes and qualitative improvements highlighting the adaptation of body systems, their complex evolution and coordinated integration within a unitary whole (Ionescu, 2013).

Among non-genetic factors, a significant place is taken by physical exercise, which has a positive influence on the body growth and development. Systematically practiced, it is one of the key factors for both obtaining a harmonious physical development of the body and maintaining its good condition. Any motor action which is systematically practiced and appropriately dosed develops the musculoskeletal system by toning up the muscles, strengthening the joints, improving oxygenation, enabling thermo-genesis (Predescu & Popescu, 2011). At the same time, physical exercise engages other systems in the activity, having a direct influence on the full body growth and development.

The growth and development of children with Down syndrome take place at a specific rate and have a number of special peculiarities (Arnheim & Sinclair, 1995). Thus, children with Down syndrome grow much slowly and can be shorter than the other children (Marcason, 2016).

Early specialised intervention, consisting of a combination between different therapies and motor activity, has positive effects not only on the general health condition and functional skills of the child with Down syndrome, but also on his/her growth and development (Teodorescu, Bota, & Stănescu, 2007; Marcason, 2016; Boer & Moss, 2016).

Research Questions

The systematic practice of swimming, as part of the intervention programme addressing Down syndrome teenagers, supports and stimulates their growth process so that they reach the maximum limits of growth imposed by their genetic background.

Purpose of the Study

The study exploits the somatic growth data (anthropometric data) of three Down syndrome adolescents (one girl and two boys aged 12 years, Tanner stage III). The anthropometric evaluation of the subjects was conducted at the beginning of the research (initial testing) and 12 months later, at the end of the research. During that period of time, the study subjects followed an intervention programme consisting of swimming classes practiced at a rate of 1 class per week.

The proposed intervention programme is based on the aerobic effort specific for swimming. Such a programme was carefully monitored and took into consideration the clinical peculiarities and related diseases of the three subjects involved. Their participation in the swimming classes of the intervention programme was not constant. It was conditioned by multiple other variables, among which we mention: children’s IQ and mental age, season illnesses, number of individual swimming classes conducted with each child, other sporting and/or social activities involving the subjects at their school or association, other unexpected situations occurred during the research etc. However, during the year when the intervention programme was implemented, each adolescent participated in minimum 39 swimming classes (Figure 01 ).

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To note that the parents of Down syndrome children were informed about the scientific research we wanted to carry out. They gave their consent for the participation of children in the evaluation tests, as well as in the swimming classes in the intervention programme. We also received their consent for interpreting and processing the data and disseminating the research results. We also mention that the research took into consideration the provisions of WMA Declaration of Helsinki (2013) on the ethical principles for studies conducted on human subjects.

Research Methods

The anthropometric measurements carried out involved several parameters, because the aim was to obtain a detailed overview of the somatic growth evolution in Down syndrome adolescents following the practice of aerobic exercise. The reference literature studied provides many anthropometric data related to the nutritional status of Down syndrome children (Bull, 2011; Marcason, 2016; Aguero, Llorente, Cabello, Rodrıguez, & Casajus, 2017). But the above-mentioned literature provides little information related to other auxological anthropometric parameters for children with trisomy 21.

Therefore, our research aims to bring to the attention of experts data/issues about Down syndrome adolescents and to warn on the need of having a centralised database containing all such data concerning the Down syndrome population.

The somatic growth assessment is conducted by means of an anthropometric examination that provides objective data on the body size, shape and proportions, the nutrition status and body composition (Ionescu, 2013). Cordun (2009) specifies that such an examination includes physical anthropometric measurements (somatometry or somatic anthropometry) and functional anthropometric measurements (physiometry).

Somatometry evaluates the longitudinal, transverse, sagittal and circumferential dimensions of the body. Cordun (2009) adds to the body weight, skinfolds and body composition, which aim at the somatic mass dimensions.

To assess the somatic growth of the three Down syndrome adolescents included in the research, we used:

Findings

Conclusion

Following the research, we have reached the following conclusions:

• Supporting and stimulating the growth and development processes in Down syndrome adolescents involve early implementation of individualised intervention programmes. The effect of such an initiative lasts long. Programmes must be constantly applied, and the child’s progress must be permanently monitored. Based on such evaluations, the future approach directions can be established;

• The systematic practice of aerobic exercise by the children involved in the research emphasised its beneficial influence on the bio-psycho-socio-motor level;

• During the research, Down syndrome adolescents experienced an increase in their anthropometric parameters. They grew in height (especially due to lower-limb length growth), gained better posture in their current activities and developed their rib cage and chest expansion. Moreover, Down syndrome children have a special phenotypic expression that is also reflected by a disproportion between the limb length and the body height (Haveman, 2007), which is also noticed in our subjects;

• Although it is not possible to determine the extent to which swimming has contributed to the achievement of the maximum potential imposed by the genetic factor, it has been found that the statural growth recorded during the research maintains our subjects above the average height for Down syndrome adolescents of similar age and gender;

• Preparation of national growth charts for Down syndrome children is required, because monitoring the anthropometric parameters of the somatic growth is important in auxological and diagnosis terms, enabling the identification of the existence or first appearance of co-morbidities typical for the chromosomal abnormality;

• The study results highlighted the positive effects of aerobic exercise not only on the anthropometric parameters, but also on the functional parameters (which is also confirmed by the studies of Boer & Moss, 2016). This aspect is also reflected by the results at the regular mandatory medical examinations (electrocardiography) undergone by these adolescents and also by functional parameters like thoracic mobility or chest expansion, which has increased;

• The other activities within the intervention programme (handmade therapy, art therapy etc.) do not have an influence on the research results, because they do not involve aerobic effort. Also, during our research, Down syndrome children did not practice any other sports discipline, which might have influenced their growth results;

• Gains obtained at the somatic growth level will be observed over time. They will strengthen the health condition of these adolescents, but will also influence their daily lives through the improved wellness level.

Acknowledgments

The paper is achieved and published under the aegis of the National University of Physical Education and Sports of Bucharest, as a partner of the programme co-funded by the European Social Fund within the Operational Sectorial Programme for Human Resources Development 2007-2013 through the project Pluri- and interdisciplinarity in doctoral and post-doctoral programmes Project Code: POSDRU/159/1.5/S/141086, its main beneficiary being the Research Institute for Quality of Life, Romanian Academy.

Authors’ contributions

All authors contributed equally to this study and should be considered as main authors.

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