28 | Akwa | December 2022 / January 2023 / February 2023 higher medical expense than those with- out CHD. Additionally, this cost may have increased in the last 13 years due to infla- tion. On the upside, with age, these costs decrease but still take a financial toll on families. Aquatics is a cost-effective exer- cise remedy for those with DS, poten- tially lowering future medical costs by improving health. In an Australian-based study, hydrotherapy/swimming classes were the cheapest therapeutic modality (mean cost of $1,442 per year) used by individuals with DS compared to speech therapy (mean = $1,878 per year) and occupational therapy (mean =$1,505 per year) (Geelhoed et al. 2011). So, considering all this, how can group classes be modified to be more inclu- sive for those with disabilities? Just like with any other exercise class, the goal is to improve the physical fitness of your participants through aquatic movement. This is no different in the case of partic- ipants with Down Syndrome; however, there may be a slower progression in skill development. Individuals with DS have a lower level of cardiorespiratory fitness than the general population – including those with disabilities besides DS (Dodd & Shields 2005). Due to this fact, class times should be shorter in duration, at least in the beginning, and exercise intensity should begin low and gradually progress. Include proper warm-up and cool-down exercises and expand these segments if needed. Since individuals with DS may have heart abnormalities and hearing problems, take special care to help participants understand that they should monitor their exercise intensity. They should cease exercise if they develop symptoms such as angina, excessive shortness of breath, or abnormal pain. Common parame- ters such as target heart rate may not be suitable when working with these par- ticipants, so other measures of intensity, like VO2 max or exertion scales (such as the Aquatic Exercise Intensity Scale), may also be more appropriate. Exercise parameters for this population are vari- able. However, the American College of Sports Medicine generally recommends that cardiorespiratory exercise sessions for those with DS should have a duration of 30 minutes, three times a week, at an intensity of 50-75% of VO2 max (Dodd & Shields 2005). Now that we have established our FITT (frequency, intensity, time, and type) principle, consideration should be given to needed changes when moving from land to water. Several land-based studies and analyses have found cardiorespira- tory exercise beneficial for those with Down Syndrome. Hardee and Fetters (2017) found that exercise improves balance, endurance, muscular strength, and endurance, as well as the ability to complete activities of daily living. A similar review by Dodd and Shields (2005) reported improvements in max- imum workload achieved, time to exhaustion, and peak minute ventilation with exercise intervention. Comparable results have been reported from aquatic exercise programs, with Boer and Beer (2019) reporting significant increases in aerobic and functional capacity and improved musculature strength and endurance following aquatic exercise. In addition, a study centered around swimming skills reported improvements in VO2 max, muscular strength, swim- ming skills, and cognition (Naczk et al. 2021). These results support the notion that aquatic aerobic exercise classes can be of similar benefit as land-based exer- cise and therapy alternatives. Unlike land-based regimens, the aquatic environment removes some barriers to exercise for this population. People with DS may be more prone to injury when performing resistance exercise because of hypotonic muscles and ligamentous laxity. The water minimizes this risk; vis- cosity, surface tension, buoyancy, and reduced gravitational effects allow for an assisted range of motion with a safe resistance level. Resistance exercises should be incorporated into aquatic exercise routines using surface area and additional equipment as participants progress. Aquatic classes should include aerobic and resistance components of functional fitness to improve the quality of life for those with DS. Use exercises such as squats, lunges, deep-water run- ning, high knees, and more to facilitate physical, mental, and social growth for those with Down Syndrome. Additionally, incorporating elements of aquatic yoga or HIIT exercises could be greatly beneficial as they target bal- ance and cardiorespiratory endurance in fun ways. Any exercise is better than no exercise for this population. Thus, monitor exercise difficulty to ensure participants feel safe and successful and to encourage adherence for continued health improvements. Aquatic exercise classes are a safe, excit- ing, and inexpensive way for those with Down Syndrome to improve their health and well-being. While individuals with DS may benefit from individualized aquatic therapy sessions, group-based aquatic exercise classes serve not only to improve physical fitness but social and emotional fitness as well. Since this pop- ulation has a lower standard fitness level than many others, make accommoda- tions in exercise difficulty, intensity, and duration should when appropriate. This substandard fitness level puts the Down Syndrome population at a greater risk of diseases including type 2 diabetes, car- diovascular disease, obesity, and osteo- porosis, making involvement in physical activity even more important (Dodd & Shields 2005). As participants progress and return to class, all these accommodated areas can increase to improve their health and challenge their newly developed skills. Instructors and classmates should encourage participation and reassure students with DS to maintain retention. Instructors should provide one-on-one assistance when necessary and take care to promote independence by using encouraging words and exercises that mimic activities of daily living. Now that you know what to do to promote exer- cise for those with Down Syndrome, apply these principles to those with other disabilities, and let’s encourage everyone to get physical! n Resources For a complete listing of resources from this article, please email julie@aeawave. org. Author Abigail Roop is a current senior studying Exercise Physiology at West Virginia University. She has a background in swim instruc- tion and specifically instructed many special needs students. Abigail will attend medical school at West Virginia University next year and aspires to be a Dermatologist.
