Benefits of Treadmill Training for Patients with Down Syndrome: A Systematic Review
Abstract
:1. Introduction
1.1. Health Complications Associated with Down Syndrome
1.2. Motor Development and Cognitive Function in Down Syndrome
1.3. Obesity and Alzheimer’s Disease in Down Syndrome
1.4. Treadmill Training as a Physical Therapy Method
1.5. Evaluating the Effectiveness of Treadmill Training for Down Syndrome
2. Materials and Methods
2.1. Research Question
2.2. Objectives of Systematic Review
- Determine various effects of treadmill training, alone or combined with physiotherapy among children and adults with Down syndrome;
- Assess the quality of the included RCTs using the Cochrane risk-of-bias tool for randomized trials;
- Analyze and compare the results of the selected studies.
2.3. Search Strategy and Selection Process
2.4. Eligibility Criteria
- Types of studies: Randomized controlled, quasi-experimental, or clinical trial or pilot study published in English or Polish in peer-reviewed journals published from the inception of the database until 21st February 2023.
- Participants: Study participants with Down syndrome from all age groups.
- Intervention: Studies in which participants undergo treadmill training, alone or combined with physiotherapy.
- Comparison: Control groups formed only with patients with DS, who were offered only standard physiotherapy care or no therapeutic intervention.
- Outcome: In order to be included in the analysis, the study had to use a defined clinical outcome relating to mental or physical health in Down syndrome.
2.5. Risk of Bias Assessment
2.6. Data Extraction
2.7. Data Analysis
3. Results
3.1. Study Characteristics of Included Studies
3.1.1. Study Design
3.1.2. Setting
3.1.3. Participants
Characteristics
Number of Participants, Method of Recruitment, and Other Relevant Information
3.1.4. Interventions
Treadmill Training Interventions in Various Studies
Treadmill Training with Orthoses and Virtual Reality
Treadmill Training Duration and Intensity
Combining Treadmill Training with Other Physical Therapy Interventions
3.1.5. Outcome Assessment Tools
Walking Onset and Gait Patterns in Infants
Motor and Cardiovascular Function
Protein Oxidation and Plasma Leptin Levels
Executive Function, Cognitive Performance and Verbal Fluency
3.2. Outcomes
3.3. Ethical Issues Concerning Studies Involving Infants and Children
3.4. Risk of Bias
- Domain 1: Risk of bias arising from randomization process
- Domain 2: Risk of bias due to deviations from the intended interventions
- Domain 3: Risk of bias due to missing outcome data
- Domain 4: Risk of bias in measurement of the outcome
- Domain 5: Risk of bias in selection of the reported results
Randomized Controlled Trials | Domain 1 | Domain 2 | Domain 3 | Domain 4 | Domain 5 | Overall |
---|---|---|---|---|---|---|
Ulrich et al. (2001) [33] | Some concerns | Low risk | Low risk | Low risk | Low risk | Some concerns |
Wu et al. (2007) [36] | Low risk | Some concerns | High risk | Low risk | Low risk | High risk |
Looper et al. (2010) [42] | HIgh risk | High risk | High risk | Some concerns | Low risk | High risk |
Lin et al. (2012) [47] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Ordonez et al. (2013) [46] | Some concerns | Low risk | Low risk | Low risk | Low risk | Some concerns |
Ordonez et al. (2014) [48] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Chen et al. (2014) [50] | HIgh risk | Some concerns | Low risk | Low risk | Low risk | High risk |
Chen et al. (2015) [52] | Some concerns | Some concerns | High risk | Low risk | Low risk | High risk |
Alsakhawi et al. (2019) [8] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Randomized Trials with no Control | Domiain 1 | Domain 2 | Domain 3 | Domain 4 | Domain 5 | Overall |
Wu et al. (2008) [37] | Some concerns | Low risk | Low risk | Low risk | Low risk | Some concerns |
Ulrich et al. (2008) [38] | Some concerns | Some concerns | High risk | Low risk | Low risk | High risk |
Angulo-Barroso et al. (2008) [39] | Some concerns | Some concerns | High risk | Low risk | Low risk | High risk |
Angulo-Barroso, Wu et al. (2008) [40] | Low risk | Some concerns | Low risk | Low risk | Low risk | Some concerns |
Wu et al. (2010) [43] | Low risk | Some concerns | Some concerns | Low risk | Low risk | Some concerns |
EL-Meniawy et al. (2012) [45] | Some concerns | Low risk | Low risk | Low risk | Low risk | Some concerns |
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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No. | Study | Duration | Design | Intervention | Age | Co-Morbidities |
---|---|---|---|---|---|---|
1 | Ulrich et al. (1992) [31] | 11 months | Single group design | Supported treadmill stepping for infants with DS | 7 months | Congenital heart defects (n = 5) |
2 | Ulrich et al. (1995) [32] | 4–21 months | Single group design | Longitudinal supported treadmill stepping for infants with DS | 8–11 months | Congenital heart defects (n = 5) |
3 | Ulrich et al. (2001) [33] | Until independent walking | Randomized controlled trial | Treadmill stepping practice for infants with DS | 307.4 days | Congenital heart disease requiring surgery (SG: n = 7, CG: n = 2) |
4 | Carmeli et al. (2002) [34] | 6 months | Parallel group design | Treadmill walking program for adults with DS | 63 years | SG: Cardiac disease (n = 2) |
5 | Carmeli et al. (2004) [35] | 15 weeks | Parallel group design | Treadmill walking program for ID adults with arterial occlusive disease | SG: 65.5 years, CG: 62 years | Arterial occlusive disease |
6 | Wu et al. (2007) [36] | Until 3 independent steps + 1 and 3-month follow-up | Randomized controlled trial | Different treadmill interventions for infants with DS | SG: LG—21.4 months, HI—19.2 months, CG: 23.9 months | Not reported |
7 | Wu et al. (2008 [37]) | LG group—11 months, HI group—9.6 months + 1-year follow-up | Randomized trial (no control) | Treadmill interventions for newly walking toddlers with DS | HI group: 9.65 months, LG group: 10.40 months | Not reported |
8 | Ulrich et al. (2008) [38] | Until 3 independent steps | Randomized trial (no control) | Individualized, progressively intense treadmill training for infants with DS | HI group: 9.65 months, LG group: 10.40 months | Congenital heart defects (HI: n = 8, LG: n = 6) |
9 | Angulo-Barroso et al. (2008) [39] | 15 months + 1-year follow-up | Randomized trial (no control) | Higher intensity, individualized TMT protocol for infants with DS | HI group: 9.65 months, LG group: 10.40 months | Not reported |
10 | Angulo-Barroso, Wu et al. (2008) [40] | 15 months + 1-year follow-up | Randomized trial (no control) | Long-term effect of different treadmill interventions on gait patterns in infants with DS | HI group: 9.7 months, LG group: 10.40 months | Not reported |
11 | Mendonca et al. (2009) [41] | 12 + 28 weeks | Single group design | 28-week training program for DS males to improve aerobic capacity and locomotor economy | 34.5 years | Not reported |
12 | Looper et al. (2010) [42] | Until 3 independent steps + 1-month follow-up | Randomized controlled trial | Early orthosis use combined with treadmill training in infants with DS vs. treadmill training alone | SG: 578 days, CG: 642 days | Not reported |
13 | Wu et al. (2010) [43] | Until 3 independent steps + 1-year gait follow-up | Randomized trial (no control) | Different treadmill interventions on joint kinematic patterns in infants with DS | LG: 35.7 months, HI: 75 months | Not reported |
14 | Ordonez et al. (2010) [44] | 12-week training | Parallel group design with matched control | Aerobic training for reducing protein oxidation | 16.3 years | Not reported |
15 | El- Meniawy et al. (2012) [45] | 3 months intervention + 3-month follow-up | Randomized trial (no control) | Treadmill training vs. suspension therapy on balance in children with DS | 9.34 years | Not reported |
16 | Ordonez et al. (2013) [46] | 10-week aerobic training program | Randomized controlled trial | Aerobic training on plasma adipokines in obese women with DS | EG: 24.7 years, CG: 25.1 years | Obesity, mild ID |
17 | Lin et al. (2012) [47] | 6-week program + 6-week follow-up | Randomized controlled trial | Strength and agility training for adolescents with DS | SG: 10.6 years, CG: 11.2 years | Not reported |
18 | Ordonez et al. (2014) [48] | 10-week aerobic training program | Randomized controlled trial | Aerobic training on pro-inflammatory cytokines and acute phase proteins in women with DS | EG: 24.7 years, CG: 25.1 years | Obesity |
19 | Rodenbusch et al. (2013) [49] | Only intervention | Single group design | Effects of upward treadmill inclination on gait of children with DS | 8.43 years | Not reported |
20 | Chen et al. (2014) [50] | ~20 min (only intervention) | Randomized controlled trial | Relation between grip strength, anthropometric factors, and aerobic exercise impact on grip strength in young men with DS | EG: 21.76 years, CG: 17.77 years | Not reporte |
21 | Rosety-Rodriguez et al. (2014) [51] | 10-week aerobic training program + 6-month follow-up | Parallel group design with matched control | Reduced inflammation effects maintenance after aerobic program completion | EG: 24.7 years, CG: 25.1 years | Obesity, mild ID |
22 | Chen et al. (2015) [52] | ~20 min (only intervention) | Randomized controlled trial | Impact of single exercise intervention on executive function in young adults with DS | EG: 23.45 years, CG: 20.58 years | Not reported |
23 | Chen et al. (2016) [53] | ~20 min (only intervention) | Parallel group design with matched control | Dose-response relationship between acute exercise intensity and cognitive performance | MI: 23.7 years, HI: 22.10 years, CG: 19.11 years | Not reported |
24 | Chen et al. (2019) [54] | ~20 min intervention + 5–10 min rest + ~1.5 h verbal tests | Parallel group design with matched control | Relationship between acute exercise and verbal fluency | MI: 21.42 years, HI: 22.70 years, CG: 20.58 years | Not reported |
25 | Alsakhawi et al. (2019) [8] | 4 months | Randomized controlled trial | Core stability training vs. treadmill exercises on balance in children with DS | 4.59 years | Not reported |
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Kamińska, K.; Ciołek, M.; Krysta, K.; Krzystanek, M. Benefits of Treadmill Training for Patients with Down Syndrome: A Systematic Review. Brain Sci. 2023, 13, 808. https://doi.org/10.3390/brainsci13050808
Kamińska K, Ciołek M, Krysta K, Krzystanek M. Benefits of Treadmill Training for Patients with Down Syndrome: A Systematic Review. Brain Sciences. 2023; 13(5):808. https://doi.org/10.3390/brainsci13050808
Chicago/Turabian StyleKamińska, Karolina, Michał Ciołek, Krzysztof Krysta, and Marek Krzystanek. 2023. "Benefits of Treadmill Training for Patients with Down Syndrome: A Systematic Review" Brain Sciences 13, no. 5: 808. https://doi.org/10.3390/brainsci13050808