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exercise as it relates to disease

This a critique of the journal article ‘Resistance circuit training reduced inflammatory cytokines in a cohort of male adults with Down syndrome’ by Rossety-Rodriguez et al, 2013.

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What is the background to this research?
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The average life expectancy of people with intellectual disorders (ID) has been rising in recent years and the cause and understanding of this is starting to be researched further. Down syndrome (DS) is one of these ID’s and is seen to often be associated with obesity, metabolic disease and diabetes. This is, in part, due to the intellectual limitations that characterise the disorder; not allowing for persons with DS to implement knowledge of exercise and nutrition. These comorbidities are to the detriment of the person and are additional diseases that can possibly be limited with lifestyle changes. Given that DS is a genetic disorder and cannot be cured or stopped, research that contributes to limiting the associated comorbidities often seen in people with DS, is a good strategy to better management of the condition. Many studies have been completed focusing on exercise based interventions in order to combat further disease. However, the study completed by Rosetty-Rodriguez et al, 2013, is the first to target circuit resistance training in order to reduce systemic inflammation in persons with DS.

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Where is the research from?
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The research primarily came from the University of Cadiz in Spain as well as the Juan amon Jimenez hospital in Spain. Several departments of the university and hospital contributed. '''

What kind of research was this?
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This study was a prospective randomized controlled trial of sedentary males with DS in Spain.

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What did the research involve?
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40 male subjects with DS were used for this study and were all cleared by physicians to partake in physical activity. 24 of these subjects were randomly chosen to partake in a circuit of resistance training exercises for 12 weeks, 3 times a week (see image). The remaining 16 participants were the control group and were matched in terms of gender, age and BMI. Prior to commencing the exercise prescription, all participants were required to have some measurements taken. These measurements included plasma levels of leptin, adipoleptin and TNF as well as waist circumference and body composition. The circuit training as seen in (image) targets upper and lower body muscles and participation in the exercise was overseen by physiotherapists to ensure safety and correct execution. In addition to the exercise prescribed, participants also did a 5-10 minute warm-up and cool down. Intensity levels of exercise were based on prior measurements (75% of 8RM). The ‘timed get up and go test’ (TGUG) was performed by all participants to use a baseline measure for ability to do functional activities. The TGUG test requires the participant to sit in a chair with back to the chair, legs apart and arms on arm rests; then proceed to get up walk three metres to a marked out line and then return to the chair and return to sitting. This test was done initially and then 12 weeks later (after the exercise intervention) and times were compared.

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What were the basic results?
''' The results yielded from the tests showed that the participants who did the resistance training circuit significantly improved there time on the TGUG functional test compared to the control group. In addition levels of leptin, TNF and interleukin-6 (IL6) were decreased in the participants who partook in the exercise program as opposed to the controls. Body composition was also shown to improve in the exercised participants in terms of a reduction in fat mass and a smaller waist circumference. No change in adipoleptin was found.

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How did the researchers interpret the results?
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The researchers interpreted the results to suggest that circuit based resistance training lowers systemic inflammation in young male adults with DS. However the researches acknowledged that not only was this a short (12 week) study that also no follow up was done to see if participants continued to exercise in this manner or if systemic inflammatory markers remained low.

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What conclusions should be taken away from this research?
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This study showed that resistance training may be beneficial in reducing systemic inflammation in persons with DS, though previous studies have also shown the positive effects of aerobic training. The conclusion can be made that exercise (of any format) is beneficial for persons with DS in order to limit or prevent the development of secondary diseases or conditions like insulin resistance or metabolic syndrome. However it is important the exercise is easily understood and done safely by the person. This study also showed that resistance training can improve functional tasks which is important for everyday actions and events. Furthermore an increased functional movement capacity could help persons with DS retain or gain jobs that require these skills. As the majority of persons with DS are employed to do more physical based jobs than intellectual

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What are the implications of this research?
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Due to the results yielded from this study more research is expected to be partaken in to further test the effectiveness of resistance training in lowering systemic inflammation. These studies will most likely include a longer period of testing as well as follow ups, as this was identified as a weakness of the current study. In addition to this, it continues to push forward research and testing into better identifying key interventions to improve the quality of life of people with DS. It also works toward limiting the prevalence of associated comorbidities found in people with ID’s and more specifically down syndrome.

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