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The goal of the study is to compare BMI indicators in children who regularly do sports, participating in the Special Olympics (SO) with non-sporty children, show the trend of BMI indicators, and to find out whether the 2-month of summer holidays have any effect on BMI indicators. An InBody device was used. Participants are children and adolescents with intellectual disability (ID). In total, four measurements of children were carried out over the course of 2 years. Total participants SO is n = 14, n = 18, n = 18, and n = 13 (13.6 ± 2.8 aged). Non-sporty children is n = 35, n = 37, n = 38, and n = 46 (12.5 ± 3.1 aged). Participants SO have 1.48 lower BMI values, 1 kg more muscle mass, and 1.3 kg less fat. During the summer holidays, participants SO have an increase in muscle mass (BMI and fat remain unchanged). For non-sporty children, all indicators decrease over the summer holidays (BMI, muscle mass, and fat). Participants SO have better results in all BMI indicators compared to non-sporty children. The results clearly show the great importance of sports and the positive effects of physical activities for children and adolescents with ID.
Faculty of Sports Studies of Masaryk University, Department of Social Sciences and Sport Management, Brno, Czech Republic
Hana Válková
Faculty of Sports Studies of Masaryk University, Department of Social Sciences and Sport Management, Brno, Czech Republic
*Address all correspondence to: jitka198@seznam.cz
1. Introduction
Overweight and obesity in children are the most significant public health problems and deserve attention in the health care system [1, 2]. Over the past 40 years, the number of obese children and adolescents worldwide has increased 10x (from 11 million to 124 million) [2].
Increased body weight (especially in adolescents) is more common in people with intellectual disability (ID), which is a risk factor for various other diseases [3, 4]. About 47% of adults with ID are obese, and their physical activity levels are insufficient to prevent the disease [5, 6, 7].
The situation is similar for children with ID. Children and adolescents with ID are highly prone to obesity, and they often suffer from obesity of the first and second degree [8, 9] and, compared to children without ID, they have far more health problems, which include autism, Down syndrome, epilepsy, cerebral palsy, motor problems, constipation, osteoporosis [10, 11, 12], delayed child development, speech problems, and behavioral problems [13].
The risk of overweight and obesity decreases with increasing severity of intellectual disability [14]. In the adult population with ID, women, people with Down syndrome, and people with mild ID have a higher prevalence of obesity [14, 15]. Up to 80% of obese children will be obese as adults [16].
In France, 26% of children with ID are obese and overweight [17]. In Romania, the prevalence of overweight and obesity in adolescents with ID is similar for boys and girls. Twenty-eight percent of boys are obese and 19% of boys are overweight, and 16% of girls are obese and 40% of girls are overweight [18]. In Taiwan, BMI in children and adolescents with ID was found to be related to age, but not to gender, diseases, or prescribed medications. The prevalence of obesity there is 18% [1].
In boys with ID, obesity is associated with early adolescence and with a mild and moderate ID, while in girls, obesity is associated with middle adolescence and with a mild ID [19]. Among the four groups of children, children without ID, children with mild ID, children with severe ID and children with Down syndrome, no statistically significant differences were found in relation to BMI in any category. The BMI of children with ID ranges from 18.5 to 24.9 [20].
When analyzing BMI among Special Olympics (SO) participants from different countries, it was found that participants from the USA have the highest prevalence of obesity who are three times more likely to be obese or overweight compared to participants from other countries [21, 22]. In North America, 30% of children and adolescents who regularly compete in Special Olympics are overweight or obese. The prevalence rate is highest among girls, as 54% of girls are overweight or obese. Increasing age is associated with a higher probability of being overweight and obese. Both age and gender are significant factors for obesity in children with ID [23].
The prevalence of obesity also varies by housing type. Among persons with ID in the USA, the lowest rates of obesity are those living in an institution and the highest rates of obesity are those living in their families [4, 15]. The situation in Europe is similar for children and adolescents with ID. The children who live in the children’s home are not obese, but they are normal weight or underweight. Children who live in their own family are obese or normal weight. That is children who live in a children’s home have a healthier diet compared to children who live in their family [24].
The level of physical activity is low in children and adolescents with ID [25]. Only half of children with ID have sufficient physical activity [26, 27], which is 12,000 steps per day [28, 29]. At the same time, the positive aspects of sports are therefore far more important for children with ID than for children without disabilities [30, 31]. Physical activity leads to physical and mental health [32], improves aerobic capacity of the lungs, motor skills, and coordination, and also contributes to the visibility and increase of the social status of the person, thereby increasing satisfaction in children and adolescents with ID who regularly do sports [33, 34].
The study took place for 2 years at two elementary schools in the Czech Republic and was part of the nationwide Czech Healthy Community Project, which was financed as part of the Special Olympics by the Golisano Foundation (USA). It is a completely new longitudinal research in BMI indicators in children and adolescents with ID.
BMI indicators were measured at each school a total of four times, each time in June and September, in order to find out if the 2-month summer holiday (July, August) has any effect on children’s BMI indicators.
2.1 Goal of the study
The first goal of the study is to compare BMI indicators in children who regularly do sports, participating in the Special Olympics (SO) with non-sporty children.
The second goal of the study is to show the trend of BMI indicators and to find out whether the 2-month summer holidays have any effect on BMI indicators in children.
2.2 Study participants
The study participants are children aged 6–20 years (boys and girls together). In Table 1, we see the average age of all participants. SO participants have a mean of 13.6 years and a standard deviation of ±2.8 years, and non-sporty children have a mean of 12.5 years and a standard deviation of ±3.1 years.
Age
SO Participants
Non-sporty Children
Mean
S. deviation
Mean
S. deviation
June 2017
14.3
2.8
12.2
3.2
September 2017
13.7
3.0
12.0
2.8
June 2018
13.3
3.1
13.0
2.9
September 2018
13.3
2.3
12.9
3.5
Average of four measurements
13.6
2.8
12.5
3.1
Table 1.
Characteristics of the research group according to the age of the participants.
The participants are from two elementary schools in the Zlín Region in the Czech Republic. (Both schools cooperate with the Czech Special Olympics Movement). Children have mild or moderate ID. Three children with severe ID were excluded from the study.
The number of SO participants (Table 2) was around 18 in each measurement, and the number of non-sporty children was around 40. In total, over 50 children participated in each measurement.
June 2017
September 2017
June 2018
September 2018
SO participants
14
18
18
13
Non-sporty children
35
37
38
46
Total
49
55
56
59
Table 2.
Characteristics of the examined group according to the number of participants.
SO participants are children who regularly do sports in the selected sport or sports which are organized by the Czech Special Olympics Movement (ČHSO) in the given region. Sporty children also regularly participate in sports competitions organized by the Czech Special Olympics Movement. Throughout the year, the ČHSO allows children to play sports and compete both in summer sports, e.g. athletics, swimming, bowling, football, floorball, cycling, etc., and in winter sports, e.g. downhill skiing, cross-country skiing, and snowboarding.
All participants in the study have, as part of the compulsory education at their elementary school, the subject of physical education, which has a time allowance of 2–4 hours per week (children with moderate ID have a higher number of hours of physical education at each school, which is usually in the range of 3–4 hours per week).
2.3 InBody device
The InBody 230 device was used to determine BMI indicators (Figure 1). InBody is a very accurate device that has eight touch electrodes and measures the body segment by segment. Using this device, it is possible to determine the exact composition of the body (proportion of muscle mass and body fat), the recommended minimum caloric intake, and energy expenditure in various sports.
Figure 1.
Measurements on the InBody device.
BMI or body mass index is defined in kg (a person’s weight) per m2 (the square of a person’s height). It was developed as an indicator of disease risk because as BMI increases, so does the risk of certain diseases. With the help of BMI, we can classify every adult into one of the following categories:
Underweight: under 18.5
Normal weight: 18.5–24.9
Overweight: 25–29.9
Obesity first degree: 30–34.9
Obesity second degree: 35–39.9
Obesity third degree: over 40
BMI is also used in children and adolescents (aged 5–19 years), where the measured BMI value is compared based on the child’s gender and age with the Z-score table created by the World Health Organization (WHO), separately for boys and separately for girls. This places the child in one of the following categories: severe underweight, underweight, normal weight, overweight, and obesity [35, 36].
2.4 Project management
Before the start of the study, a personal meeting was held with the principals of the cooperating schools and a Cooperation Agreement was signed with them. Consents for children’s participation in the study were then prepared for their parents, and subsequently the consents were distributed to their parents for signature. The study was also approved by the ethics committee of the Faculty of Sports Studies (FSpS) in Brno.
The management of the implementation of the study continued to ensure the dates of the measurements at the schools, to arrange a team of volunteers who went to the schools to help with the measurements and to arrange the borrowing of the InBody device from the FSpS (arranging a single date to suit everyone—it was not easy). As part of the management of the entire project, it was necessary to ensure: uniform T-shirts for volunteers, transport for volunteers, refreshments for all measurement participants (which was a great motivation for the children to participate in the study), and advertising banner with the sponsor’s logo. Forms for measurements and other small things (disinfection, writing accessories, tape measure, etc.) were also provided.
Before the actual measurement, the station was being prepared. That is, InBody had to be near an electrical outlet, at another station a meter was placed on the wall to measure the children’s height, another station consisted of a table with chairs—the entrance interview with the children took place there, etc.
Measuring children on the InBody was not easy at all, both for the children and for the trained person operating the device (volunteer). It was very difficult for the children to stand still for about 30 seconds on the electrodes of the device and to hold the handles of the device in the given places with their hands. Often the children only measured themselves on the second or third attempt.
2.5 Data analysis
The analysis and evaluation of the data were in program Statistica and Excel. Using normality tests, we found that these are nonparametric data. That is, the data do not fit a Gaussian normal distribution, and therefore, the median (a nonparametric quantity) is presented in the results instead of the arithmetic mean (a parametric quantity that does not fit this data).
Analysis of variance, specifically Friedman’s ANOVA, was used to detect statistically significant differences at the 5% significance level (four measurements were carried out at each school, on the same group of participants, so these are dependent data). In Table 3, we can see that there is a statistically significant difference only between the data in the muscle category in non-sporty children.
Category
Friedman ANOVA
p
BMI—SO participants
0.69859
BMI—non-sporty children
0.26948
MUSCLES—SO participants
0.43215
MUSCLES—non-sporty children
0.01066
FAT—SO participants
0.29574
FAT—non-sporty children
0.85901
Table 3.
Analysis of variance—Friedman ANOVA.
Due to the longitudinal research, data analysis (BMI, muscle, and fat) is also carried out in terms of development trends.
3.1 Comparison of BMI values in SO participants and non-sporty children
In Figure 2, we can see that SO participants have lower BMI values than non-sporty children throughout the research period. Therefore, SO participants have a slimmer figure.
Figure 2.
Comparison of trends in BMI.
SO participants have a convex trend where they have a different BMI value in each measurement. Summer holidays therefore have no effect on the BMI value.
Non-sporty children have an unbalanced trend. They always have a lower BMI value in September (in September 2017, they have 18.4 and in September 2018 they have 20), i.e. summer holidays cause a decrease in BMI. And this change is not statistically significant (see Table 3).
If we compare the children’s BMI according to their age (Table 1) with the WHO tables created for children (both with the table for boys and with the table for girls), we find that all participants are in the normal-weight category throughout the research period.
When comparing the descriptive statistics (Table 4), we see a larger range in BMI values for non-sporty children, as the minimum measured BMI values are around 12.30 and the maximum around 101. For SO participants, the minimum BMI values are around 13.10 and the maximum values around 32. Here, we see a big difference in the maximum measured values.
BMI
SO Participants
Non-sporty Children
Non-sporty children difference
Median
S. deviation
Min
Max
Median
S. deviation
Min
Max
Compared to SO participants
June 2017
19.35
4.71
14.30
30.20
21.40
25.11
14.10
101.00
2.05
September 2017
18.15
3.68
13.90
28.70
18.40
7.75
12.30
50.40
0.25
June 2018
18.50
4.79
13.10
32.90
20.35
14.44
13.70
101.00
1.85
September 2017
18.90
4.58
15.20
32.40
20.00
13.79
12.90
101.00
1.10
Median of four measurements
18.70
4.65
14.10
31.30
20.18
14.12
13.30
101.00
1.48
Table 4.
Descriptive BMI statistics.
Non-sporty children have a higher BMI value of 0.25 to 2.05. During the entire period of the 2-year research, SO participants have a clearly lower BMI value of 1.48 on average compared to non-sporty children.
3.2 Comparison of MUSCLES values in SO participants and non-sporty children
SO participants have an unbalanced trend (Figure 3). They always have a higher muscle value in kg in September (in September 2017, they have 19.5 kg and in September 2018 they have 18.5 kg of muscle), i.e. summer holidays cause an increase in muscle mass. And this change is not statistically significant (see Table 3).
Figure 3.
Comparison of trends in muscle.
Non-sporty children have an unbalanced trend. They always have a lower muscle value in kg in September (in September 2017, they have 16.6 kg and in September 2018 they have 18.5 kg of muscle), i.e. summer holidays cause a loss of muscle mass. And this change is statistically significant (see Table 3).
When comparing the descriptive statistics (Table 5), we see that non-sporty children have less muscle by 2 kg (June 2017) and 2.85 kg (September 2017) in the first two measurements. In the third measurement, non-sporty children have 3.40 kg more muscles, and in the last measurement, both groups have the same amount of muscle.
Muscles
SO Participants
Non-sporty Children
Non-sporty children difference
Median
S. deviation
Min
Max
Median
S. deviation
Min
Max
Compared to SO participants
June 2017
19.00
6.70
5.00
29.90
17.00
7.26
2.70
34.90
−2.00
September 2017
19.45
9.04
1.40
42.40
16.60
8.29
1.50
42.10
−2.85
June 2018
16.20
10.55
3.50
44.00
19.60
8.02
6.80
46.00
3.40
September 2017
18.50
5.70
9.30
30.00
18.50
8.09
8.20
36.70
0.00
Median of four measurements
18.75
7.87
4.25
36.20
17.75
8.05
4.75
39.40
−1.00
Table 5.
Descriptive statistics of muscles in kg.
From the point of view of the measured minimum values and also according to the standard deviation, we see a greater range of muscle mass in sports children. SO participants have on average 1 kg more muscles than non-sporty children.
3.3 Comparison of FAT values in SO participants and non-sporty children
In Figure 4, we see that SO participants (blue color) have lower body fat values than non-sporty children in three out of four measurements.
Figure 4.
Comparison of trends in fat.
SO participants have a convex trend where they have a different amount of fat in kg at each measurement. Summer holidays have no effect on body fat.
Non-sporty children have an unbalanced trend. They always have a lower fat value in kg in September (in September 2017 they have 9.3 kg and in September 2018 they have 10.4 kg of fat), i.e. summer holidays cause body fat loss. And this change is not statistically significant (see Table 3).
When comparing the descriptive statistics (Table 6), we see that non-sporty children have more fat by 1.25 to 5.40 kg in the first three measurements. In the last measurement, non-sporty children have 0.80 kg less fat.
Fat
SO Participants
Non-sporty children
Non-sporty children difference
Median
S. deviation
Min
Max
Median
S. deviation
Min
Max
Compared to SO participants
June 2017
12.95
8.50
2.60
29.70
14.30
9.95
0.70
43.60
1.35
September 2017
8.05
8.07
1.40
29.90
9.30
15.34
0.60
74.20
1.25
June 2018
6.10
9.00
0.90
34.90
11.50
13.06
1.20
68.00
5.40
September 2017
11.20
8.36
3.00
34.50
10.40
11.72
1.00
47.00
−0.80
Median of four measurements
9.63
8.43
2.00
32.20
10.95
12.39
0.85
57.50
1.30
Table 6.
Descriptive statistics of fat in kg.
From the point of view of the maximum and minimum values and also according to the standard deviation, we see a greater range of body fat in non-sporty children. SO participants have an average of 1.3 kg less fat than non-sporty children.
The results clearly show that SO participants have a lower BMI value of 1.48, and they also have 1 kg more muscle and 1.3 kg less fat compared to non-sporty children. Sports and physical activity are therefore important factors for children with ID in shaping their body composition. A number of authors agree on the positive effects of sport for children with ID, but they describe the effects of sport rather generally, i.e. that sport in children leads to physical and psychological health [32], to the improvement of functional indicators such as increasing the aerobic capacity of the lungs, lowering the heart rate, and lowering the blood pressure. Furthermore, as a result of adaptation to physical stress, tendons become stronger, muscles grow, and bones become stronger. In the psychological field, sport leads to an increase in self-confidence, visibility, and higher subjective satisfaction of a person [33, 34, 37]. It is also proven that regular exercise has an effect on daily life in children with ID—on the area of self-care, i.e. progress was found in food, clothing, personal hygiene, and also communication [38].
For non-sporty children, their BMI values decrease during the summer holidays. It follows that during the summer holidays (when children do not have to sit in school desks for several hours every day), children have much more physical activities, which have a positive effect on their body composition. At the same time, it seems that the children only engage in spontaneous movement and not targeted sports activities, because their muscle mass and amount of fat decrease during the summer holidays. (Regular physical activity would be a prerequisite for an increase in muscle mass in children).
Both SO participants and non-sporty children are in the normal-weight category according to BMI throughout the 2-year research period. Czech children are not obese. Obesity is agreed upon by a number of foreign authors, according to which roughly 20–50% of children with ID have obesity [8, 9, 18, 21, 22].
In the Czech Republic (ČR), the school system for children with ID is well set up, as even non-sporty children are in the normal-weight category. The 2 to 4 hours of physical education per week that all children have at school is therefore sufficient for them. The whole range of activities that teachers and children engage in throughout the school year is also important. Part of the regular education includes, for example, self-service training, preparation of simple meals, various school trips during the year, music therapy, snoezelen (a specially designed room to support the perception of all the senses contains, for example, a water cylinder, starry sky, water bed, aroma lamp, etc., to calm down and reduce stress and tension), canistherapy, basal stimulation, etc. Another important factor is that only trained teachers who understand their work can work in schools in the ČR, and children therefore have professional teaching in all subjects.
SO participants have a convex trend in BMI, with summer holiday having no effect on their BMI. Non-sporty children have an unbalanced trend in BMI, and summer holidays cause their BMI values to decrease. During the entire period of the 2-year research, SO participants have a clearly lower BMI value of 1.48 on average compared to non-sporty children.
SO participants have an unbalanced trend in their muscles, and the summer holidays cause an increase in their muscle mass. Non-sporty children also have an unbalanced trend in their muscles, and summer holidays cause a decrease in their muscle mass, and this change is statistically significant. SO participants have on average 1 kg more muscles than non-sporty children.
SO participants have a convex trend in fat, with summer holiday having no effect on their fat. Non-sporty children have an unbalanced fat trend, and summer holidays cause their body fat to decrease. SO participants have an average of 1.3 kg less fat than non-sporty children.
Overall, children with ID in the Czech Republic have very good results in BMI indicators, as both sports and non-sporty children have a normal weight. Czech children have much better results in BMI indicators than children abroad.
The results clearly show the great importance of sports and physical activities for children with ID, as well as the well-established school system in the Czech Republic and its cooperation with the Czech Special Olympics Movement, which enables children to do sports all year round. The current trend of education and the Czech Special Olympics Movement should be maintained in the future.
References
1.Lin JD, Yen CF, Li CW, Wu JL. Patterns of obesity among children and adolescents with intellectual disabilities in Taiwan. Journal of Applied Research in Intellectual Disabilities. 2005;18(2):123-129. DOI: 10.1111/j.1468-3148.2005.00241.x
2.NCD Risk Factor Collaboration. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: A pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet. 2017;390:2627-2642. DOI: 10.1016/S0140-6736(17)32129-3
3.Melville CA, Hamilton S, Hankey CR, Miller S, Boyle S. The prevalence and determinations of obesity in adults with intellectual disabilities. Obesity Reviews. 2007;8(3):223-230. DOI: 10.1111/j.1467-789X.2006.00296.x
4.Rimmer JH, Yamaki K. Obesity and intellectual disability. Mental Retardation and Developmental Disability Research Reviews. 2006;12(1):70-82. DOI: 10.1002/mrdd.20091
5.Forman-Hoffman VL, Ault KL, Anderson WL, Weiner JM, Stevens A, Campbell VA, et al. Disability status, mortality, and leading causes of death in the United States community population. Medical Care. 2015;53(4):346-354. DOI: 10.1097/MLR.0000000000000321
6.Froehlich-Grobe K, Lee J, Washburn RA. Disparities in obesity and related conditions among Americans with disabilities. American Journal of Preventive Medicine. 2013;45(1):83-90. DOI: 10.1016/j.amepre.2013.02.021
7.Yu S, Wang T, Zhong T, Qian Y, Qi J. Barriers and facilitators of physical activity participation among children and adolescents with intellectual disabilities: A scoping review. Healthcare Basel. 2022;10(2):233. DOI: 10.3390/healthcare10020233
8.Heryati E, Ratnengsih E. Adaptive physical education model for increasing physical fitness of children with intellectual disability. Advances in Social Science Education and Humanities Research. 2017;118:202-207
9.Salaun L, Berthouze-Aranda SE. Physical fitness and fatness in adolescents with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities. 2012;25(3):231-239. DOI: 10.1111/j.1468-3148.2012.00659.x
10.Aljerf L, Aljurf M. Improvements in the ecological and nutritional aspects of down’s syndrome. Preprint 2020. 2020. DOI: 10.21203/rs.3.rs-30313/v1
11.Oeseburg B, Dijkstra GJ, Groothoff JW, Reijneveld SA, Jansen DE. Prevalence of chronic health conditions in children with intellectual disability: A systematic literature review. Intellectual and Developmental Disabilities. 2011;49(2):59-85. DOI: 10.1352/1934-9556-49.2.59
12.Tyler CV, Schramm S, Karafa M, Tang AS, Jain A. Electronic health record analysis of the primary care of adults with intellectual and other developmental disabilities. Journal of Policy and Practice in Intellectual Disabilities. 2010;3:204-210. DOI: 10.1111/j.1741-1130.2010.00266.x
13.Emerson E, Brigham P. The developmental health of children of parents with intellectual disabilities: Cross sectional study. Research in Developmental Disabilities. 2014;35(4):917-921. DOI: 10.1016/j.ridd.2014.01.006
14.Melville CA, Cooper SA, Morrison J, Allan L, Smiley E, Williamson A. The prevalence and determinants of obesity in adults with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities. 2008;21(5):425-437. DOI: 10.1111/j.1468-3148.2007.00412.x
15.Stancliffe RJ, Lakin KC, Larson S, Engler J, Bershadsky J, Taub S, et al. Overweight and obesity among adults with intellectual disabilities who use intellectual disability/developmental disability services in 20 US States. American Journal on Intellectual snd Developmental Disabilities. 2012;116(6):401-418. DOI: 10.1352/1944-7558-116.6.401
16.Wiklund P. The role of physical activity and exercise in obesity and weight management: Time for critical appraisal. Journal of Sport and Health Science. 2016;5(2):151-154. DOI: 10.1016/j.jshs.2016.04.001
17.Salaun L, Berthouze-Aranda S. Obesity in school children with intellectual disabilities in France. Journal of Applied Research in Intellectual Disabilities. 2011;24(4):333-340. DOI: 10.1111/j.1468-3148.2010.00612.x
18.Ungurean BC, Cojocariu A, Abalasei BA, Popescu L, Puni AR, Stoica M, et al. The analysis of the correlations between BMI and body composition among children with and without intellectual disability. Children-Basel. 2022;9(5):582. DOI: 10.3390/children9050582
19.Králíková J, Válková H. BMI indicators in children with intellectual disabilities. Studia Sportiva. 2019a;13(1):85-97. DOI: 10.5817/StS2019-1-9
20.Ungurean BC, Cojocariu A, Puni AR, Oprean A. Body mass index in children with and without intellectual disability: Distribution and implications. Proceedings of the 6th International Conference of Universitaria Consortium FEFSTIM: Physical Education, Sports and Kinesiotherapy - Implications in Quality of Life. 2020. pp. 331-335
21.Harris N, Rosenberg A, Jangda S, O’Brien K, Gallagher ML. Prevalence of obesity in International Special Olympic athletes as determined by body mass index. Journal of the American Dietetic Association. 2003;103(2):235-237. DOI: 10.1053/jada.2003.50025
22.Li H, Frey GC, McCormick BP, Johnston JD. Comparison of obesity among Chinese and US Special Olympic athletes with intellectual disabilities. Research in Developmental Disabilities. 2015;41:94-100. DOI: 10.1016/j.ridd.2015.05.005
23.Lloyd M, Temple VA, Foley JT. International BMI comparison of children and youth with intellectual disabilities participating in Special Olympics. Research in Developmental Disabilities. 2012;33(6):1708-1714. DOI: 10.1016/j.ridd.2012.04.014
24.Králíková J, Válková H. Trends in body mass index among children with mild and moderate intellectual disabilities. Studia Sportiva. 2019b;13(2):42-54. DOI: 10.5817/StS2019-2-5
25.Cho C, Shin W, Kong S. Participation in regular physical activity according to the type of disability, sex, point of disability diagnosis, and ability to walk independently in South Korea. Healthcare Basel. 2021;9(8):1079. DOI: 10.3390/healthcare9081079
26.Shields N, Dodd KJ, Abblitt C. Do children with down syndrome perform sufficient physical activity to maintain good health? A pilot study. Adapted Physical Activity Quarterly. 2009;26(4):307-320. DOI: 10.1123/apaq.26.4.307
27.Wouters M, Evenhuis HM, Hilgenkamp TIM. Physical activity levels of children and adolescents with moderate-to-severe intellectual disability. Journal of Applied Research in Intellectual Disabilities. 2019;32(1):131-142. DOI: 10.1111/jar.12515
28.Colley RC, Jansen IAN, Tremblay MS. Daily step target to measure adherence to physical activity guidelines in children. Medicine and Science in Sports and Exercise. 2012;44(5):977-982. DOI: 10.1249/MSS.0b013e31823f23b1
29.WHO. Global recommendations on physical activity for health. Geneva, Switzerland: WHO; 2010b
30.Dykens EM, Rosner BA, Butterbaugh G. Exercise and sports in children and adolescents with developmental disabilities - Positive physical and psychosocial effects. Child and Adolescent Psychiatric Clinics of North America. 1998;7(4):757. DOI: 10.1016/S1056-4993(18)30210-4
31.Zull A, Tillmann V, Froboese I, Anneken V. Physical activity of children and youth with disabilities and the effect on participation in meaningful leisure-time activities. Cogent Social Sciences. 2019;5(1). DOI: 10.1080/23311886.2019.1648176
32.Kapsal NJ, Dicke T, Morin AJS, Vasconcellos D, Maiano C, Lee J, et al. Effects of physical activity on the physical and psychosocial health of youth with intellectual disabilities: A systematic review and meta-analysis. Journal of Physical Activity & Health. 2019;16(12):1187-1195. DOI: 10.1123/jpah.2018-0675
33.Johnson CC. The benefits of physical activity for youth with developmental disabilities: A systematic review. American Journal of Health Promotion. 2009;23(3):57-167. DOI: 10.4278/ajhp.070930103
34.Lahtinen U, Rintala P, Malin A. Physical performance of individuals with intellectual disability: A 30-year follow-up. Adapted Physical Activity Quarterly. 2007;24(2):125-143. DOI: 10.1123/apaq.24.2.125
35.WHO. A healthy lifestyle - WHO recommendations. 2010a. Retrieved from: http://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi (see 27 July, 2022)
36.WHO. BMI for age 5-19. 2007. Retrieved from: https://www.who.int/toolkits/growth-reference-data-for-5to19-years/indicators/bmi-for-age (see 27 July, 2022)
37.Jančík, J., Závodná, E., Novotná, M. Fyziologie tělesné zátěže-vybrané kapitoly. Brno: Masarykova Univerzita. 2006. Retrieved from: https://is.muni.cz/elportal/estud/fsps/js07/fyzio/texty/index.html (see 29 July, 2022)
38.Chadwick OB, Cuddy M, Kussel Y, Taylor E. Handicaps and the development of skills between childhood and early adolescence in young people with severe intellectual disabilities. Journal of Intellectual Disability Research. 2005;49(12):877-888. DOI: doi.org/10.1111/j.1365-2788.2005.00716.x
Written By
Jitka Kampasová and Hana Válková
Submitted: 01 August 2022Reviewed: 24 August 2022Published: 10 October 2022
Open access peer-reviewed chapter
