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. Author manuscript; available in PMC: 2023 Dec 1.
Published in final edited form as: J Policy Pract Intellect Disabil. 2022 Jul 1;19(4):408–418. doi: 10.1111/jppi.12434

Physical Activity and Physical and Mental Health in Middle-Aged Adults with Down Syndrome

Victoria Fleming 1,2, Brianna Piro-Gambetti 1,2, Benjamin Handen 3, Bradley T Christian 1,3, Annie Cohen 4, Dana Tudorascu 4, David T Plante 5, Ozioma Okonkwo 6, Sigan L Hartley 1,2
PMCID: PMC9788305  NIHMSID: NIHMS1811763  PMID: 36570324

Abstract

Background:

Adults with Down syndrome have an increased risk of aging-related physical and mental health conditions and experience them at an earlier age than the general population. There is a need to investigate modifiable lifestyle factors that may reduce risk for these conditions.

Method:

The present study investigated the associations between physical activity (i.e., sedentary behavior and moderate-to-vigorous activity) assessed via accelerometer across 7 days and caregiver-reported physical and mental health of 66 non-demented middle-aged adults with Down Syndrome aged 25–55 years (52% female).

Results:

Regression analyses indicated that more time spent in moderate intensity physical activity was associated with less risk of sleep apnea (b = −.031 p = .004) and endocrine/metabolic conditions (b = −.046 p = .009), and lower total number of physical health conditions (b = −.110 p =.016) and anxiety disorders (b = −.021 p =.049) after controlling for relevant sociodemographics. After also adjusting for BMI, the association between time spent in moderate intensity physical activity and sleep apnea (b=−.035, p = .002), endocrine/metabolic conditions (b=−.033, p = .045) and total physical health (b=−.091, p =.026) remained significant Unexpectedly, time spent in sedentary behavior was negatively associated with musculoskeletal conditions (b=−.017, p = .044).

Conclusion:

Findings indicate important associations between physical activity in everyday life and the physical and mental health of adults with Down syndrome. Social policies and interventions aimed at reducing time spent sitting around (i.e., sedentary behavior) and encouraging moderate-to-vigorous activity may be a low-burden and low-cost mechanism for fostering healthy physical and mental aging in the Down syndrome population.

Keywords: Intellectual Disability, Policy, Down Syndrome, Physical Activity, Physical and Mental Health

Down syndrome (DS) is a developmental disability caused by the triplication of chromosome 21 that occurs in 1 in 700 live births in the United States (Presson et al., 2013). Through medical breakthroughs and improvements in care over the last half century, the average life expectancy in DS is now in the 60s (Hodapp et al., 2015). As the DS population lives longer, however, there is a need for research on how to support healthy aging. Efforts to identify modifiable lifestyle factors as a means to promote heathy aging in DS are appealing as they can be low-cost and low-burden and applied at a population-level through policy and intervention.

A substantial body of research has shown that medical conditions and physical and functional changes associated with aging occur more frequently and at an earlier age in DS relative to the general population (Carfi et al., 2014; Franceschi et al., 2019; Zigman, 2013). These medical conditions include Alzheimer’s disease (Mccarron et al., 2014); however, an emerging body of research has explored the effect of lifestyle on Alzheimer’s disease in DS (e.g., Cody et al., 2020; Mihaila et al., 2019) and thus the current study is focused on other aging-related physical health conditions. Adults with DS are at high risk for endocrine/metabolic, musculoskeletal, sleep, and cardiovascular impairments. The prevalence of hypothyroidism is estimated to be 63% in middle-aged adults with DS (Aversa et al., 2015; Guaraldi et al., 2017). Hyperthyroidism is more prevalent in adults with DS than in adults in the general population and thought to be mainly caused by Graves’ disease (Goday-Arno et al., 2009). Adults with DS are also more likely than adults in the general population to have celiac disease (Real de Asua et al., 2015) and diabetes (Alexander et al., 2016). Vitamin D and B12 deficiencies have also been reported in DS, and associated with obesity and autoimmune disease (e.g., celiac disease) (Stagi et al., 2014).

Adults with DS are also at high risk for declines in bone mineral density compared to the general population, making them vulnerable to osteoporosis and bone fractures (Capone et al., 2017; Carfi et al., 2017). Atlantoaxial instability has a prevalence of 8 to 11% in DS (Real De Asua et al., 2015; Tsou et al., 2020). Gout also occurs at an elevated rate in adults with DS as compared to the general population (Capone et al., 2017). Adults with DS are also at high risk for obstructive sleep apnea with a prevalence of 40–80% (Trois et al., 2009).

Obesity is common in adults with DS, with estimates that 45–79% of males and 56–96% of females with DS are obese (Bell & Bhate, 1992; Melville et al., 2005). In terms of cardiovascular conditions, individuals with DS have a 40 to 50% incidence of congenital heart disease (Benhaourech et al., 2016), and this is associated with later risk of pulmonary hypertension (Baraona et al., 2013). Hyperlipidemia is also prevalent in DS (Adelekan et al., 2012). Although trisomy 21 is associated with reduced risk of hypertension and atherosclerosis (Alexander et al., 2016; Roy-Vallejo et al., 2020), it is also related to an elevated risk of hypotension (Alexander et al., 2016), cardiac valve pathology (Capone et al., 2018; Kennedy et al., 2018), and strokes (Sobey et al., 2015).

Adults with DS are also at risk for mental health conditions (Dykens, 2007; Tassé et al., 2016), with depression and anxiety problems and disorders being common (Dykens, 2007; White et al., 2005). Other reported mental health problems include psychotic symptoms (e.g., hallucinations) and anger problems (Dykens et al., 2015, Urv et al., 2010). Rates of mental health problems have been found to increase with age such that middle-aged adults with DS have more mental health problems than young adults with DS (Tassé et al., 2016).

Physical Activity and Sedentary Behavior

Given the high rate of health problems in adults with DS, there is an important need to identify policies and interventions to support healthy aging in this population. A large body of research on the general adult population has documented the benefits of physically activity lifestyles – both more time spent in moderate-to-vigorous physical activity and les time spent in sedentary behavior (i.e., sitting or lying down) - for physical and mental health (Hallgren et al., 2016; Teychenne et al., 2010). In cross-sectional studies, more time in moderate-to-vigorous activity has been related to fewer respiratory infections (Eliakim, 2016; Ravaglia et al., 2001) and less time in sedentary behavior and high moderate-to-vigorous physical activity has been associated with better endocrine functioning including reduced risk of diabetes (Sigal et al., 2018). In older men from the general population, higher moderate-to-vigorous activity has been found to be associated with improved thyroid functioning (Ravagia et al, 2001) and less musculoskeletal impairment and pain (e.g., Narwrocka et al., 2019). Both lower sedentary behavior and higher moderate-to-vigorous physical activity have also been related to reduced risk of obstructive sleep apnea (e.g, Hall et al., 2020) and obesity in general population adults (Fanning et al., 2018).

Physical activity has also been shown to be positively associated with mental health, including lower levels of anxiety and depression symptoms in adults from the general population (Goldstein et al., 2020; Teychenne et al., 2010). For example, exercise training programs have been shown to lead to improved global mental health and increased adaptive responses to stress (Goldstein et al., 2020). Similarly, women who report a high level of sedentary behavior (e.g., sitting at the computer and overall sitting time) have a greater likelihood of depression than those who engage in less sedentary behavior (Teychenne et al., 2010).

To-date, little is known about the potential beneficial effects of physical activity for the physical or mental health of adults with DS. Yet, this topic has particular relevance to the DS population. Adults with intellectual and developmental disabilities, including those with DS, engage in less overall physical activity than their peers without disabilities (Izquierdo-Gomez et al., 2014; Cowley et al., 2010). Studies have also reported that individuals with DS spend more time spent in sedentary behavior than the general population (Gabel et al., 2016; Ramirez-Rico et al., 2014; Philips & Holland, 2011), with time spent in sedentary behavior associated with increased age among adults with DS (Matthews et al., 2008; Whitt-Glover et al., 2009). Two recent studies also found an association between more time spent in sedentary behavior and increased risk of obesity in adults with intellectual disability, including those with DS (Hsieh et al., 2017; Melville et al., 2018). In part, DS is associated with chronotropic incompetence, low muscular strength, and muscle hypotonia, which may make engagement in moderate-to-vigorous physical activity challenging (Phillips & Holland, 2011).

The goal of the present study was to examine the association between physical activity and the physical and mental health of adults with DS. Physical health was assessed through body-mass-index (BMI) and the presence (vs. absence) of caregiver-reported cardiovascular conditions, sleep apnea, musculoskeletal conditions and endocrine/metabolic conditions. These conditions were selected because they occur at an increased prevalence in DS and have important associations with physical activity in other populations. Mental health was assessed through caregiver-report of the presence (vs. absence) of diagnosed mental health conditions related to mood. Physical activity was assessed through a wrist-worn accelerometer for seven days. Two indices of physical activity were used – percent of time per day in sedentary activity and in moderate-to-vigorous activity. We hypothesized that adults with DS who engaged in less moderate-to-vigorous physical activity and more sedentary behavior would evidence a greater number of physical and mental health conditions and higher BMI.

Methods

Participants

Sixty-six adults with DS from two sites (University of Wisconsin – Madison and University of Pittsburgh) involved in the Alzheimer’s Biomarker Consortium on Down Syndrome (ABC-DS; https://www.nia.nih.gov/research/abc-ds) participated. Study inclusion criteria included being aged 25 years or older, mental age of ≥30 months, genetic testing confirming DS, no conditions contraindicative for brain imaging scans (e.g., pregnant or breastfeeding or metal in the body) due to imaging protocols for the larger ABC-DS study. Participants did not have dementia based on a clinical consensus process that involved at least three study staff (one of which was a licensed psychologist) and was informed by directly-administered measures and caregiver-reports of dementia symptoms, cognitive decline, and daily living skills (See Handen et al., 2020 for details of the consensus process). The Internal Review Board of both sites reviewed and approved the study. Consent was obtained from the adult with DS or their legal guardian, with assent obtained from adult with DS in the latter case. Adults with DS ranged in age from 25 to 55 years, with a mean of 38 years old (SD = 8.20). The majority of participants were white non-Hispanic (97%), with 2 participants identifying as multi- or bi-racial. The majority of participants lived with family (64%). On average, participants had a mental age of 7.67 (SD = 3.30) and about half were female (n=34). Table 1 provides additional participant sociodemographics.

Table 1.

Participant Characteristics and Mean, Standard Deviation, range for Study Variables

Total (N=66)
Female, No. (%) 34 (53%)
Chronological Age in years, M (SD) 37.77 (8.20)
Mental age in years*, M (SD) 7.67 (3.30)
Race
 White (Non-Hispanic), No. (%) 64 (97%)
 Bi/Multiracial, No. (%) 2 (3%)
Residence, No. (%)
 With Family 42 (64%)
 Independently 10 (15%)
 Group Home 10 (15%)
 Supported Apartment 2 (3%)
 Other 2 (3%)
Physical Health, M (SD), range
 Total Physical Health Conditions 3.21 (2.06), 0–8
 Cardiovascular Conditions 1.15 (1.10), 0–4
 Sleep Apnea 0.48 (0.50), 0–1
 Musculoskeletal Conditions 0.29 (0.52), 0–2
 Endocrine/metabolic Conditions 0.92 (0.81), 1–3
 Body Mass Index 33.95 (8.60), 19.14–56.70
Mental Health, M (SD), range
 Total Mental Health Conditions 0.41 (0.70), 0–2
 Depressive Conditions 0.18 (0.39), 0–1
 Anxiety Conditions 0.26 (0.47), 0–2
Physical Activity, M (SD)
 % daytime in Sedentary 43.81 (10.45)
 Minutes in Sedentary 534.04 (172.19)
 % daytime in Moderate-to-vigorous 10.52 (6.79)
 Minutes in Moderate-to-vigorous 135.00 (98.52)
 Wear time, M (SD) 1268 (250.14)
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Note.

*

Based on Peabody Picture Vocabulary Test

Procedure

The adult with DS and a caregiver attended a two-day visit to complete the larger ABC-DS study, which involved reporting on the adult with DS’s physical and mental health. Following this visit, the adult with DS wore a wrist-worn actigraph accelerometer for 7 consecutive days as they went about their normal activities. The adult with DS and their caregiver also completed a daily activity record, which was used to help validate and interpret accelerometer data. The adult with DS and caregiver were each paid $50 for this portion of the study.

Measures

Control Variables.

Age was calculated in years using date of birth and date of study visit. The Peabody Picture Vocabulary Test- Fourth Edition (Dunn & Dunn, 2007) was administered to estimate the adult with DS’s mental age in years. This measure is reliable and valid in DS and highly correlated with overall IQ (Phillips, Loveall, Channell, & Conners, 2014). Intellectual disability level was coded: mild: ≥ 9 years, moderate: 4 to 8 years, and severe: ≤ 3 years. Biological sex was reported by caregivers and coded: male = 0 and female = 1. Data collection site was coded: University of Wisconsin – Madison = 1 and University of Pittsburgh = 2.

Physical Health.

BMI was assessed by measuring the adult with DS’s height and weight, using the formula - kg/m2, with kg being weight in kilograms and m2 being height in meters squared. Caregivers reported on the presence (versus absence) of physical conditions known to be prevalent in DS based on prior literature. Cardiovascular conditions involved congenital heart disease, pacemaker, syncope/simple faints, hypertension, hypotension, hyperlipidemia and an ‘other’ category. Given the high prevalence of sleep apnea in DS and its important relation to healthy aging a in DS (Hartley & Esbensen, 2022), sleep apnea was in its own category. Musculoskeletal conditions included osteoarthritis (except for cervical degenerative joint disease), osteoporosis/osteopenia, rheumatoid arthritis, gout/hyperuricemia and an ‘other’ category. Endocrine/metabolic conditions included hypothyroidism, hyperthyroidism, Hashimotos thyroiditis, diabetes, vitamin D and b12 deficiencies, and an ‘other’ category. Study staff went over the health forms with caregivers to provide explanations and answer questions. Conditions were coded 1=present, 0=absent and summed for each category. A Total Physical Health score was created by summing all categories.

Mental Health.

Study staff also read caregivers a list of mood mental health conditions and caregivers were asked to indicate which (if any) had been diagnosed by a health provider in the adult with DS. These conditions included having a depressive disorder (e.g., major depression, bipolar, dysthymia, seasonal affective disorder) or having an anxiety disorder (e.g., generalized anxiety, obsessive-compulsive, panic, post-traumatic stress, social phobia) Analyses focused on the presence of a depressive disorder (0 = absent, 1 = present) or anxiety disorder (0 = absent, 1 = present). A Total mental health score was also examined and created by tallying the total number of depressive and anxiety disorders.

Physical Activity.

Over 7 consecutive days, participants wore a wrist-worn GT9X Actigraph accelerometer with a sampling frequency of 30 Hz, 60-s epoch on their non-dominant wrist. Accelerometers are reliable and valid measures of physical activity (Hwang et al., 2018). Participants were instructed to wear the monitor at all times, except long-duration water-based activities (e.g., swimming). Only wake time data was analyzed and Troiano (2008) wear time validation algorithms on ActiLife (version 6.13.4) were used. The Freedson Adult (1998) uniaxial (axis 3) cut points were analyzed (Leinonene et al., 2017) based on counts per minute: sedentary (<99 cpm), light physical activity (100–1951 cpm), moderate physical activity (1952–5724 cpm), vigorous physical activity (5725–9498 cpm), very vigorous physical activity (>9499 cpm).

Data Analysis Plan

Descriptive statistics, histograms, and boxplots were used to examine the distribution of study variables and identify any outliers. Pearson and point-by-serial correlations were conducted to examine the association between sociodemographic control variables (i.e., age, biological sex, site, and intellectual disability level) and physical activity and physical and mental health variables. Sociodemographic variables significantly associated with these main study variables were then included as control variables in models. Generalized linear regressions were conducted. Percent of time spent in sedentary behavior and in moderate-to-vigorous activity were entered as independent variables and the physical health (BMI and physical health conditions) and mental health variables (presence of mood conditions) were the dependent variables. Entering both moderate-to-vigorous activity and sedentary behavior into each model, allowed us to determine their independent effect on health. Relevant sociodemographic variables (i.e., those significantly related to physical activity and/or health outcomes) were also entered into the regression model as controls. Finally, we re-ran the above regressions but controlled for BMI in order to determine the effect of physical activity after controlling for differences in BMI on health conditions.

Results

Sociodemographic and preliminary Analyses

Twenty (30%) participants had a mild level of intellectual disability, 42 (64%) had a moderate level of intellectual disability, and 4 (6%) had a severe level of intellectual disability. The mean BMI was 33.95 (SD = 8.60), with 59% (n = 39) of participants in the obese range (i.e., BMI>30kg/m2). Figure 1 presents the percentage of participants reported to have each of physical and mental health condition. The most common cardiovascular conditions were congenital heart disease (48%) and hyperlipidemia (17%). The most common musculoskeletal conditions were osteoarthritis (14%) and gout/hyperuricemia (11%). The most common endocrine conditions were hypothyroidism (58%) and vitamin D deficiency (15%). Sleep Apnea occurred in 42% of the sample. In terms of mental health conditions, 23% of participants had an anxiety disorder and 18% had a depressive disorder.

Figure 1.

Figure 1.

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Number and Prevalence of Physical and Mental Health Conditions in Adults with Down Syndrome

Percent of time spent in sedentary behavior and in moderate-to-vigorous activity had a normal distribution without skew (kurtosis: 0.83 and 0.77, respectively). The average accelerometer wear time was 1268.37 minutes (SD = 250.144), with mean daily percent time in sedentary behavior of 43.81 (SD = 10.45) and in moderate-to-vigorous physical activity of 10.52 (SD = 6.79). The average time spent in sedentary behavior was 534.04 minutes (SD = 172.19) and the average time spent in moderate-to-vigorous activity was 135.00 minutes (SD = 98.52). All of the time spent in the moderate-to-vigorous category across all participants occurred in the moderate range (1952–5724 cpm); no participant reached the vigorous or very vigorous physical activity intensity level.

Twenty (30%) participants had a mild level of intellectual disability, 42 (64%) had a moderate level of intellectual disability, and 4 (6%) had a severe level of intellectual disability. The mean BMI was 33.95 (SD = 8.60), with 59% (n = 39) of participants obese (i.e., BMI>30kg/m2). Figure 1 presents the percentage of participants reported to have each of physical and mental health condition. Pearson and point by serial correlations were used to examine associations between sociodemographics (age, biological sex, site, and intellectual disability level) and main study variables (physical activity and health variables) in order to determine which of these variables should be entered as controls in regression analyses. Chronological age was significantly associated with total number of mental health conditions (r = .269, p=.029). Biological sex was significantly positively associated with presence of endocrine conditions (r = .248, p=.045) and BMI (r = .320, p=.012). The University of Pittsburgh site was significantly associated with having participants with sleep apnea (r = .509, p<.001), endocrine conditions (r = .276, p=.025) and a higher total number of physical health conditions (r = .280, p=.023) than the University of Wisconsin – Madison site. Intellectual disability level and average wear time were not significantly associated with physical activity or health variables.

Physical Activity and Physical and Mental Health

Table 2 presents results of regression models examining the association between percentage of time in sedentary behavior and in moderate-to-vigorous activity and physical and mental health variables. In contrast to our hypothesis, sedentary behavior was significantly positively associated with musculoskeletal conditions, after controlling for age (b=−.017, p = .044). There were no other significant associations between percent of time spent in sedentary behavior and health conditions. In line with our hypotheses, percent of time spent in moderate-to-vigorous physical activity was significantly negatively associated with sleep apnea (b=−.031, p = .004), endocrine conditions (b=−.046, p = .009), total number of physical health conditions (b=−.110, p = .016) and anxiety disorders (b=−.021, p = .049). There were no other significant associations between moderate-to-vigorous physical activity and health conditions.

Table 2.

Standardized regression betas models of the association between sedentary behavior and moderate-to-vigorous physical activity and physical and health conditions.

Cardiovascular Conditions Sleep Apnea Musculoskeletal Conditions Endocrine/ metabolic Conditions Body Mass Index Total Physical Health Total Mental Health Depressive Disorders Anxiety Disorders
Age -- −.011 .007 -- -- -- 0.025 -- ---
Sex -- -- -- .445 5.677 -- -- -- ---
Site 0.733 0.615 -- 0.522 -- 1.474 -- -- ---
Sedentary −.016 −0.002 −0.017* −0.012 0.027 −0.046 0.015 0.003 0.003
Behavior
Moderate −0.018 −0.031** −0.016 −0.46** −0.210 −0.110* −0.011 −0.009 −0.021*
Physical
Activity
Model Fit R 2 0.080 0.411 0.103 0.233 0.138 .162 .161 0.047 .117
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Note. Sociodemographics significantly related to the health condition or to physical activity were included as controls.

*

P <.05

**

P <.01

Follow-up analyses were run to determine if physical activity continued to be related to physical and mental health conditions, after controlling for BMI. After controlling for BMI, sedentary behavior continued to be significantly negatively associated with musculoskeletal conditions (b=−.020, p = .016). Percent of time in moderate-to-vigorous physical activity continued to be significantly associated (in positive and negative directions, respectively) with sleep apnea (b=−.035, p = .002), endocrine conditions (b=−.033, p = .045) and total physical health (b=−.091, p = .026). The associations between moderate-to-vigorous activity and anxiety disorders became non-significant (p >. 050) after accounting for BMI.

Discussion

There is an abundance of research demonstrating the beneficial effects of physically active lifestyles on physical and mental health in the adult non-DS populations. (e.g., Chen & Ringenbach, 2018; Mikkelsen et al., 2017). However, limited research has investigated whether physical activity is similarly a modifiable mechanism for healthy physical and mental aging in DS. The goal of the current study was to evaluate the association between physical activity in everyday life and the physical and mental health of middle-aged adults with DS.

In line with previous research (e.g., Capone et al., 2017), our sample of adults with DS had a high frequency of physical and mental health conditions. The most frequent conditions were hypothyroidism (58%), congenital heart disease (48%), sleep apnea (42%), anxiety (23%), depression (18%), and hyperlipidemia (17%). In support of our hypothesis, engaging in less moderate-to-vigorous physical activity was associated with greater likelihood of having sleep apnea, endocrine/metabolic conditions, and anxiety disorder, and fewer overall physical health problems. These associations were found in models controlling for relevant sociodemographics, as well as, average time spent in sedentary behavior. It is important to note that none of the adults with DS engaged in activity above a moderate intensity level (i.e., no one reached a vigorous or very vigorous level); this finding is in line with previous reports that adults with DS have difficulty reaching vigorous physical activity intensity levels (Oreskvoic et al., 2020; 2022). Thus, going forward, we will frame our discussion on time spent in moderate intensity physical activity. Overall, our findings indicate that engaging in moderate intensity physical activity has important associations with physical and mental health in adults with DS, and these effects are apart from how much time is spent in sedentary behavior.

In contrast to our hypotheses, when adjusting for time spent in moderate intensity physical activity, time spent in sedentary behavior was only associated with musculoskeletal conditions and this association was in contrast to our hypothesis. Specifically, adults with DS who spent more time in sedentary behavior had less musculoskeletal conditions. The most common musculoskeletal condition was osteoarthritis for which regular movement can help ease pain and stiffness (Davis & Kotowski, 2015). Thus, it could be that adults with DS with musculoskeletal problems were more likely to move around at a light intensity level relative to those without these conditions. However, it is important to note that the presence of musculoskeletal conditions was not associated with more moderate intensity physical activity.

The current study cannot address the direction of effects between physical activity and health. In line with findings from non-DS populations (e.g., Almeida et al., 2006; Menai et al., 2017), more time spent in at least moderate intensity physical activity may protect against sleep apnea, endocrine/metabolic conditions, anxiety disorders and total physical health problems in adults with DS. In other words, it may be that higher engagement in moderate intensity activity decreases the risk for sleep apnea in adults with DS. This benefit may in part be driven by obesity, as has been shown in the general population (Igelström et al., 2013). However, in the current study, the association between physical activity and sleep apnea remained after adjusting for BMI, suggesting that physical activity could have protective effects via mechanisms such as strengthening upper airway muscles to increase upper airway tonus (Vincent et al., 2002), decreasing nasal resistance (Bussierse et al., 2000), and/or altering the distribution of fat (Kairaitis et al., 2003). Similarly, moderate intensity physical activity could lead to improvements in endocrine/metabolic functioning in adults with DS, given evidence of beneficial effects of physical activity on fluctuating hormones and regulation of metabolism in non-DS populations (Hackney & Lane, 2015). However, these beneficial effects may operate at least in part through obesity, as the association between moderate-to-vigorous activity and endocrine/metabolic conditions was no longer significant after adjusting for BMI.

Increased time spent in moderate intensity physical activity may also decrease anxiety, in adults with DS. Physical activity has been shown to help individuals regulate emotions and intrusive thoughts (Abramovitch, Goldzweig, & Schweiger, 2013) and promotes a sense of self-achievement and self-efficacy in general population samples (Paluska & Schwenk, 2000). Moreover, there is evidence that physical activity acts as a mood regulator, reducing inflammation and influencing neurotransmitters (e.g., noradrenaline, dopamine, and serotonin) in ways that improve mood (Mikkelsen et al., 2017). The potential beneficial effect of more moderate intensity physical activity on anxiety appears to be operate independent of BMI.

However, in the other direction, it is also possible that the presence of health problems, including obstructive sleep apnea, endocrine/metabolic conditions, and mental health conditions including anxiety, may lead to lower physical activity in DS. For example, obstructive sleep apnea and thyroid disorders can cause fatigue and reduced motivation to engage in physical activity. Similarly, anxious affect have been shown to be associated with lower motivation to be physically active in other populations (Dugan et al., 2015; Forsyth et al., 2015). Moreover, it could be that both pathways are true and physical activity is linked to physical and mental health in feedback loops of bidirectional influence. Future studies should test these possibilities.

The study should be interpreted in light of its limitations. The sample was small, lacked racial/ethnic diversity, and was limited to non-demented adults with DS with a mental age of ≥ 3 years. Future research should include a larger and more diverse sample to determine if findings generalize to the broader DS population. Secondly, we assessed physical activity across a week in everyday life. Future studies should examine history of physical activity, as the effect of physical activity on health may be better conceptualized in longer-term patterns of activity (e.g., activity across their 30s and 40s). Third, the current study focused on caregiver-reported presence of physical health and mental health conditions. Future studies should include biofluid markers of health and/or physical or psychological exams, and a broader list of physical and mental health conditions, such as atlantoaxial instability, hearing problems, and disruptive behaviors. Finally, longitudinal studies are needed to establish directional (and perhaps bidirectional) pathways between physical activity and physical and mental health and the specific mechanisms of effect.

In summary, lifestyles with higher moderate intensity physical activity may be important for healthy physical and mental aging in adults with DS. If confirmed in future longitudinal studies, findings have critical implications for informing population-based policies and interventions on how on to support healthy aging in DS. For example, such policies and interventions could include promoting and incentivizing physical activity through mass media campaigns, making extracurricular physical activity mandatory at day programs and implementing interventions that address barriers to physical activity.

Table 3.

Standardized regression betas for models of the association between sedentary behavior and moderate-to-vigorous physical activity and physical and health conditions when controlling for Body-Mass-Index

Cardiovascular Conditions Sleep Apnea Musculoskeletal Conditions Endocrine/ metabolic Conditions Total Physical Health Total Mental Health Depressive Disorders Anxiety Disorders
Age -- −0.013 0.001 -- -- 0.016 -- ---
Sex -- -- -- 0.227 -- -- -- ---
Site 0.785 0.489 -- .263 .995 -- -- ---
Sedentary −0.014 −0.005 −0.020* −0.009 −0.045 0.11 0.003 0.002
Behavior
Moderate 0.012 −0.035** −0.017 −0.33* −0.91* −0.007 −0.004 −0.016
Physical
Activity
Model Fit R 2 0.098 0.416 0.182 0.370 0.354 0.261 0.148
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Note. Sociodemographics significantly related to the health condition or physical activity were included as controls.

*

P<.05

Funding:

The research was funded by the National Institute of Aging (R01 AG070028; U19 AG070043; U01AG051406; R01AG031110; R01 AG076640) and the National Institute on Child Health and Human Development (U54 HD090256; P50HD105353)

Footnotes

Authors have no conflict of interest to declare.

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