According to the results of a recent randomized controlled trial (ClinicalTrials ID .gov: NCT04767412) published in the Physical Medicine and Rehabilitation Archives.

Recognizing that children with DS often have low aerobic capacity, heart rate and peak muscle strength – all of which are considered key factors contributing to lower fitness in this population – the researchers sought to assess the impact of aerobic exercise on fitness and the effect of IMT on respiratory muscle strength in these individuals. Additionally, researchers sought to compare the effectiveness of combined aerobic exercise plus IMT versus aerobic exercise alone in improving physical fitness in children with DS.

A total of 40 girls and boys aged 7 to 10 years (mean age, 7.8 ± 1.5 years) participated in the current study. Participants were randomly and evenly divided into 2 groups (A and B). The study was conducted between October 2020 and December 2020. All patients were recruited from a private physiotherapy center located in Egypt. The inclusion criteria for the study were as follows: (1) BMI: from the 5th percentile to less than 85th percentile; (2) ability to understand and follow verbal commands and instructions used during training and testing.

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All study participants in Groups A and B received 30 minutes of aerobic exercise 3 times a week for 12 weeks. Those in Group B also received an additional 30 minutes of IMT before each aerobic exercise session. The primary outcome measure was participants’ physical fitness, which was assessed before and after treatment using the following tools: (1) the 6-minute walk test (6MWT), to assess aerobic capacity; (2) the Gio digital manometer, to detect the intensity of IMT and the improvement in the strength of the respiratory muscles after the training program; and (3) the Brockport Physical Fitness Test (BPFT), which provides a health-related assessment of aerobic functioning in children with disabilities.

The investigators evaluated the results of the following measurements: maximum inspiratory pressure (MIP); maximum expiratory pressure (MEP); submaximal aerobic endurance using 6MWT strength; and endurance using the curl-up, dumbbell press, trunk lift, standing long jump, seated push-ups, pull-ups, bent-arm hangs, and sit-up and stretch tests. the back saver. By intra-group post hoc analysis, a statistically significant difference (P

Following use of the intervention, participants in Group B demonstrated significant improvements in MEP; MIP; and test scores for 6MWT, curl-up, dumbbell press, trunk raise, standing long jump, seated push-ups, pull-ups, bent arms hanging and back sparing seated and reach tests (P

A main limitation of the current study is its small sample size, due to the exclusion of children who engaged in regular physical activity. In addition, the schooling of children aged 7 to 10 only could limit the generalizability of the results.

The investigators concluded that aerobic physical training and IMT “significantly improved the physical fitness of children with DS”, with the combination of aerobic and inspiratory muscle training resulting in the most significant improvement. Based on their findings, they recommended that further research investigate “the effect of IMT on quality of life” and “on long-term goals in children with DS.”


Elshafey MA, Alsakhawi RS. Inspiratory muscle training and fitness in children with Down syndrome: a randomized controlled trial. Arch Phys Med Rehabilitation. Published online May 6, 2022. doi:10.1016/j.apmr.2022.04.005