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The ability to perform instrumental activities of daily living (IADL) is important for one's level of independence. A high incidence of limitations in IADL is seen in older adults with intellectual disabilities (ID), which is an important determinant for the amount of support one needs. The aim of this study was to assess the predictive value of physical fitness for the ability to perform IADL, over a 3-year follow-up period, in 601 older adults with ID. At baseline, an extensive physical fitness assessment was performed. In addition, professional caregivers completed the Lawton IADL scale, both at baseline and at follow-up. The average ability to perform IADL declined significantly over the 3-year follow-up period. A decline in the ability to perform IADL was seen in 44.3% of the participants. The percentage of participants being completely independent in IADL declined from 2.7% to 1.3%. Manual dexterity, balance, comfortable and fast gait speed, muscular endurance, and cardiorespiratory fitness were significant predictors for a decline in IADL after correcting for baseline IADL and personal characteristics (age, gender, level of ID, and Down syndrome). This can be interpreted as representing the predictive validity of the physical tests for a decline in IADL. This study shows that even though older adults with ID experience dependency on others due to cognitive limitations, physical fitness also is an important aspect for IADL, which stresses the importance of using physical fitness tests and physical fitness enhancing programs in the care for older adults with ID., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

A high incidence of limitations in daily functioning is seen in older adults with intellectual disabilities (ID), along with poor physical fitness levels. The aim of this study was to assess the predictive value of physical fitness for daily functioning after 3 years, in 602 older adults with borderline to profound ID (≥ 50 years). At baseline, physical fitness levels and daily functioning (operationalized as basic activities of daily living [ADL] and mobility) were assessed. After 3 years, the measurements of daily functioning were repeated. At follow-up, 12.6% of the participants were completely independent in ADL and 48.5% had no mobility limitations. More than half of the participants (54.8%) declined in their ability to perform ADL and 37.5% declined in their mobility. Manual dexterity, visual reaction time, balance, comfortable and fast gait speed, muscular endurance, and cardiorespiratory fitness were significant predictors for a decline in ADL. For a decline in mobility, manual dexterity, balance, comfortable and fast walking speed, grip strength, muscular endurance, and cardiorespiratory fitness were all significant predictors. This proves the predictive validity of these physical fitness tests for daily functioning and stresses the importance of using physical fitness tests and implementing physical fitness enhancing programs in the care for older adults with ID., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

A high incidence of falls is seen in people with intellectual disabilities (ID), along with poor balance, strength, muscular endurance, and slow gait speed, which are well-established risk factors for falls in the general population. The aim of this study was to assess the predictive value of these physical fitness components for falls in 724 older adults with borderline to profound ID (≥ 50 years). Physical fitness was assessed at baseline and data on falls was collected at baseline and after three years. Gait speed was lowest in participants who fell three times or more at follow-up. Gait speed was the only physical fitness component that significantly predicted falls, but did not remain significant after correcting for confounders. Falls at baseline and not having Down syndrome were significant predictors for falls. Extremely low physical fitness levels of older adults with ID, possible strategies to compensate for these low levels, and the finding that falls did not increase with age may explain the limited predictive value of physical fitness found in this study., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Heart rate recovery (HRR) after exercise is an independent predictor for cardiovascular and all-cause mortality. To investigate the usefulness of HRR in cardiorespiratory exercise testing in older adults with intellectual disabilities (ID), the aims of this study were (a) to assess HRR in older adults with ID after the 10-m incremental shuttle walking test (ISWT) and (b) its association with personal characteristics (gender, age, distance walked on the ISWT, level of ID, genetic syndrome causing ID, autism, behavioral problems, and peak heart rate (HRpeak)). HRR was assessed after the 10-m incremental shuttle walking test in 300 older adults (>50 years) with borderline to profound ID. HRR was defined as the change from HRpeak during the ISWT to heart rate measured after 1, 2, 3, 4, and 5 min of passive recovery. The largest decrease in heart rate was in the first minute of recovery leveling off toward the fifth minute of recovery. An abnormal HHR (≤12 bpm) was seen in 36.1% of the participants with Down syndrome (DS) and in 30.7% of the participants with ID by other causes. After the fifth minute the heart rates of 69.4% of the participants with DS and of 61.4% of the participants with ID by other causes returned to resting levels. HRpeak and distance walked on the ISWT were positively related to all HRR measures. More severe ID was negatively related and having DS positively related to HRR after 3-5 min of recovery. The other characteristics were not significantly associated to HRR. HRR is a potentially useful outcome measure in cardiorespiratory fitness testing of older adults with ID with a direct, objective, and non-invasive measurement. Further research is needed to identify the relation between HRR and adverse health outcomes in this population., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Although physical fitness is generally very low in older adults with intellectual disabilities (ID), levels may differ across subgroups. It is important to identify which subgroups need to be targeted specifically in physical activity and fitness interventions and reference values. Physical fitness was measured with box-and-block-test, response-time-test, Berg-balance-scale, walking speed, grip strength, 30s-chair-stand, 10 m incremental-shuttle-walking test and the extended modified-back-saver-sit-and-reach-test in a large sample of older adults with ID (n=1050), and subgroups associated with lower physical fitness levels were identified applying multivariate linear regression analyses. Both fixed personal characteristics such as being older, being female, having more severe ID and having Down syndrome and modifiable or preventable factors such as physical activity levels, mobility impairments and a need of more intensive care, are independently associated with lower levels of multiple physical fitness components. This first study identifies subgroups of older adults with ID which require adapted reference values, and subgroups that need to be specifically targeted in fitness promotion programs., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Cardiorespiratory fitness is the ability of the circulatory, respiratory and muscular systems to supply oxygen during sustained physical activity. Low cardiorespiratory fitness levels have been found in individuals with intellectual disabilities (ID), which puts them at higher risk for cardiovascular diseases and all-cause mortality. The aims of this review were to update previous reviews about (a) the cardiorespiratory fitness levels and their determinants in individuals with ID, and (b) the validity and reliability of cardiorespiratory fitness testing in individuals with ID. We searched the databases of Pubmed and Embase for relevant studies, resulting in 31 included articles. These studies mainly included younger participants with mild to moderate ID. Results confirmed previous findings of low cardiorespiratory fitness levels in individuals with ID. Cardiorespiratory fitness levels of children and adolescents with ID are already low, with further decline with increasing age. Furthermore, females have lower cardiorespiratory fitness levels than males. Physical inactivity and chronotropic incompetence are most likely to contribute to low cardiorespiratory fitness levels. Peak cardiorespiratory fitness levels of individuals with ID can be assessed with maximal treadmill protocols, after allowing for familiarization sessions. Although, predicting maximal oxygen uptake from field tests is problematic, field tests have been found valid and reliable as indicators of cardiorespiratory fitness., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

High incidence of falls and increased risk of fall-related injuries are seen in individuals with intellectual disabilities (ID). The Berg Balance Scale (BBS) is a reliable instrument for balance assessment in the population of (older) adults with ID. The aims of this study were to assess the balance capacities of a large group of older adults with ID with the BBS and look for gender and age effects, as well as reasons for drop-out on separate items, and to identify feasible subtests for subgroups in which the complete BBS is not feasible. The balance capacities of 1050 older clients with borderline to profound ID of three Dutch care-provider services (mean age 61.6 [sd=8.0]) were assessed with the BBS. The participants who completed all items of the BBS (n=508) were the functionally more able part of the study sample. Results showed that even this functionally more able part had poor balance capacities, with a mean BBS score of 47.2, 95% CI [46.3, 48.0], similar to adults in the general population aged around 20 years older. Balance capacities decreased with increasing age and females had poorer balance capacities than males. Difficulties understanding the task and physical limitations were most often the reasons for drop-out. Feasible subtests were identified for the subgroups with very low cognitive levels and wheelchair users. Low balance capacities of older adults with ID show the need for regular screening and the urge for fall prevention programs for individuals with ID., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Grip strength is an important predictor of several health outcomes in the general older population. Grip strength assessment is feasible and reliable in older adults with intellectual disabilities (ID), which makes it a valuable measurement for application in this population. The purpose of this study was to investigate the effect of handedness on grip strength in the older population with ID. Handedness and grip strength were assessed in a sample of 1050 older adults (≥ 50 years) with borderline to profound ID. Results showed that 26.2% of the study sample was left-handed. In right-handed participants the dominant hand (right) was on average 8.7% stronger than the non-dominant hand (p<0.001). For lefthanded participants there was no significant difference between the dominant hand (left) and nondominant hand. However, more detailed analyses revealed that 34.5% of the participants were stronger with their non-dominant hand, (on average 16.6% stronger for right-handed and 16.3% stronger for left-handed participants). Because of the large strength ratios, distributed in favor of both the dominant as the non-dominant hand, it is recommended to assess both hands to get a valid result of grip strength in older adults with ID., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

The circadian sleep-wake rhythm changes with aging, resulting in a more fragmented sleep-wake pattern. In individuals with intellectual disabilities (ID), brain structures regulating the sleep-wake rhythm might be affected. The aims of this study were to compare the sleep-wake rhythm of older adults with ID to that of older adults in the general population, and to investigate which factors are associated with the sleep-wake rhythm in older adults with ID. This study is part of the 'Healthy Aging and Intellectual Disabilities' study (HA-ID). We applied actigraphy in 551 persons with ID and 58 persons in the general population, aged 50 years and over. Outcome measures were stability (interdaily stability), fragmentation (intradaily variability) and amplitude (relative amplitude) of the sleep-wake rhythm. Compared to older adults in the general population, the sleep-wake rhythm of older adults with ID was significantly less stable (p=0.03), more fragmented (p<0.001) and had a lower relative amplitude (p<0.001). Multivariate regression analysis revealed that higher age, dementia, depression, visual impairment, severe hearing impairment, epilepsy and spasticity are independently associated with a more disturbed sleep-wake rhythm in this group. The sleep-wake rhythm is more stable in females and those living at a setting for more intensive care. Higher physical activity levels are strongly associated with both a less fragmented (p<0.001) and a more stable (p<0.001) sleep-wake rhythm. Higher age, dementia and depression are also associated with the sleep-wake rhythm in the general population. Neurological and sensory impairments that were associated with the sleep-wake rhythm in older adults with ID, are frequent known conditions in the ID population. Further research should focus on which factors specifically influence the sleep-wake rhythm in older adults with ID, and on the effects of more physical daytime activity on the sleep-wake rhythm in this population., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Physical fitness is as important to aging adults with ID as in the general population, but to date, the physical fitness levels of this group are unknown. Comfortable walking speed, muscle strength (grip strength), muscle endurance (30s Chair stand) and cardiorespiratory endurance (10 m incremental shuttle walking test) were tested in a sample of 1050 older adults with ID, and results were compared with reference values from the general population. Across all age ranges, approximately two-third of the entire study population scored 'below average' or 'impaired'. Even the youngest age groups (50-59 or 50-54 years) in this sample achieve similar or worse results than age groups 20-30 years older in the general population. Low physical fitness levels in older adults with ID demonstrate that this group is prone to unnecessary premature loss of functioning and health problems, and maintaining physical fitness should have priority in practice and policy., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

This study measures physical activity levels in a representative population-based sample of older adults (aged ≥ 50 years) with intellectual disabilities. For this, the steps/day of all 1050 participants of the Healthy Ageing and Intellectual Disabilities study (HA-ID; a study conducted among three Dutch healthcare providers in 2009-2010), were measured with a pedometer. Largely due to physical limitations (n = 103), walking speed <3.2 km/h (n = 252), limited understanding or non-cooperation (n = 233), only 257 of the group were able to participate in valid measurements with pedometers. Of these 257 participants, only 16.7% (95% CI 12.2-21.3) complied with the guideline of 10,000 steps/day, 36.2% (95% CI 30.3-42.1) took 7500 steps/day or more, and 39% (95% CI 32.6-44.5) was sedentary (< 5000 steps/day). Because the measured sample was the more functionally able part of the total sample, this result is likely to be a considerable overestimation of the actual physical activity levels in this population. This realistic study shows that physical activity levels are extremely low in adults aged 50 years and over with intellectual disabilities. Focus on lifetime promotion of physical activity in this specific, but rapidly growing population, is recommended., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Daily living skills are important to ageing adults with intellectual disabilities (ID). The purpose of this study was to investigate the level of these skills in older adults with ID and to investigate the influence of gender, age, level of ID and mobility on these skills. Daily living skills were measured with the Barthel Index (for Activities of Daily Living, ADL) and the Lawton IADL scale (for Instrumental Activities of Daily Living, IADL) in 989 adults with ID aged 50 years and over living in community-based and institutional settings. Descriptives were presented by categories of gender, age, level of ID and mobility. Regression analysis was used to investigate the influence of these variables on total and item scores of ADL and IADL questionnaires. ADL and IADL scores in older adults with ID are comparable to those of vulnerable patient groups. Total ADL score was mainly determined by mobility, while total IADL score was mainly determined by level of ID. Of all 18 separate items of these questionnaires, 11 were determined more by mobility than level of ID. The Barthel Index and Lawton IADL scale are recommended for future use in research and clinical practice in this group. This study stresses the need to support mobility older adults with ID as much as possible, in order to optimize independency in this group., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Problems encountered in epidemiologic health research in older adults with intellectual disabilities (ID) are how to recruit a large-scale sample of participants and how to measure a range of health variables in such a group. This cross-sectional study into healthy ageing started with founding a consort of three large care providers with a total client population of 2322 clients of 50 years and over, and two academic institutes. This consort made formal agreements about a research infrastructure and research themes: (1) physical activity and fitness, (2) nutrition and nutritional state, and (3) mood and anxiety. Subsequently, preparation was started by carefully reviewing and selecting instruments to measure a wide set of health variables to answer the research questions. Specific demands of these instruments were that they could be executed efficiently and accurately on-site in a large sample of participants and that the burden of these measurements for participants as well as their caregivers was as minimal as possible. Then, preparation was continued by designing and executing a thorough communication plan for clients, legal representatives and staff of the care providers, preceding the informed consent procedure. In this plan, which had a top-down structure, specific attention was given to personally informing and motivating of key stakeholders: the professional care givers. This preparation led to a recruitment of 1050 participants (45.2%) and to high participation rates in key parts of the assessment. A detailed description is provided about the recruitment and organization and the selected instruments., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

A certain level of physical fitness is a prerequisite for independent functioning and self-care, but the level of physical fitness declines with ageing. This applies to older adult with intellectual disabilities too, but very little is known about their actual level of physical fitness. This lack of knowledge is partly caused by a lack of suitable instruments to measure physical fitness in this group, but the search for and choice of instruments depends on the operationalisation of the concept physical fitness for specific this target population. In this article the advantages of two known definitions of physical fitness are combined, leading to a combination of seven components to describe physical fitness in older adults with intellectual disabilities: coordination, reaction time, balance, muscular strength, muscular endurance, flexibility and cardio-respiratory endurance. A literature search for all instruments to measure any of these components resulted in a large number of available instruments. These instruments were evaluated according criteria of functionality, reliability and feasibility in this target population. The aim of this article was to propose a selection of instruments which complied with these criteria and creates possibilities for widespread use and sharing and/or pooling of data. The proposed selection of tests to measure physical fitness in older adults with intellectual disabilities is: Box and Block test, Reaction time test with an auditive and visual signal, Berg balance scale, Walking speed comfortable and fast, Grip strength with a hand dynamometer, 30s chair stand, modified back saver sit and reach and the 10 m incremental shuttle walking test., (Copyright (c) 2010 Elsevier Ltd. All rights reserved.)

The focus of this review is on the close relationship between gait and cognition in ageing and associated dementias. This close relationship is supported by epidemiological studies, clinical studies of older people with and without dementia that focused on the intensity of the physical activity, clinical studies with older persons without dementia examining a relationship between gait and specific cognitive processes, and human and animal experimental studies examining a neural basis for such a relationship. Despite these findings, most studies with patients with dementia focus exclusively on the relationship between cognition and dementia, with relatively few addressing the relationship between gait and dementia. However, subtle disturbances in gait can be observed in ageing and in (preclinical) subtypes of dementia that are not known for prominent motor disturbances, i.e. Mild Cognitive Impairment, Alzheimer's Disease, vascular Cognitive Impairment No Dementia, Subcortical Ischaemic Vascular Dementia, Frontotemporal Mild Cognitive Impairment, and Frontotemporal Dementia, supporting a close relationship between gait and cognition. The relationship between gait and cognition is weakened by the few available intervention studies that examine the effects of walking on cognition in patients with (preclinical) dementia. These studies report equivocal results, which will be discussed. Finally, suggestions for future research will be made.