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Effects of Stair-Climbing Exercise on Health-Related Physical Fitness Measures in Children with Developmental Disabilities

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Title: Effects of Stair-Climbing Exercise on Health-Related Physical Fitness Measures in Children with Developmental Disabilities
Language: English
Authors: Lin Wen-Li, Chien-Lin Lin, Chin-Kai Lin (ORCID 0000-0002-4049-2842)
Source: Journal of Developmental and Physical Disabilities. 2024 36(4):681-695.
Availability: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
Peer Reviewed: Y
Page Count: 15
Publication Date: 2024
Document Type: Journal Articles
Reports - Research
Descriptors: Exercise, Physical Fitness, Measurement, Children, Developmental Disabilities, Pediatrics, Hospitals, Rehabilitation, Foreign Countries, Health
Geographic Terms: Taiwan
DOI: 10.1007/s10882-023-09927-3
ISSN: 1056-263X
1573-3580
Abstract: Children with developmental disabilities lack sufficient physical activity in their daily lives. The purpose of this study was to see if children with developmental disabilities who participated in stair-climbing exercises had better physical performance and health status than children with developmental disabilities who did not. This study adopted a pre-and-post-test experimental design, enrolling 30 subjects (experimental group, 15; control group, 15) with developmental disabilities aged 5-7 years from pediatric rehabilitation treatment departments of two regional teaching hospitals in Taiwan. The experimental group received stair-climbing exercises and physical therapy twice a week for eight consecutive weeks. The primary outcomes were health-related physical fitness assessment items, including body composition (body mass index: BMI), cardiorespiratory fitness (stair-climbing test), muscular fitness (knee-bend sit-ups), and flexibility (Chair Sit and Reach Test). The post-test measurements of BMI, cardiorespiratory fitness, sit-ups, and muscular flexibility of children in the experimental group were significantly better than the pre-test measurements. The stair-climbing exercise training results for cardiorespiratory fitness, muscular fitness, and muscular flexibility in the experimental group were significantly better than those in the control group. Stair-climbing exercise improves the physical fitness of children with developmental disabilities. The results of this study suggest that children with developmental disabilities should be encouraged to engage in this convenient and easy stair-climbing exercise to improve physical performance and health status.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1434154
Database: ERIC
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  Value: <anid>AN0178837127;jdp01aug.24;2024Aug07.05:21;v2.2.500</anid> <title id="AN0178837127-1">Effects of Stair-Climbing Exercise on Health-Related Physical Fitness Measures in Children with Developmental Disabilities </title> <p>Children with developmental disabilities lack sufficient physical activity in their daily lives. The purpose of this study was to see if children with developmental disabilities who participated in stair-climbing exercises had better physical performance and health status than children with developmental disabilities who did not. This study adopted a pre-and-post-test experimental design, enrolling 30 subjects (experimental group, 15; control group, 15) with developmental disabilities aged 5–7 years from pediatric rehabilitation treatment departments of two regional teaching hospitals in Taiwan. The experimental group received stair-climbing exercises and physical therapy twice a week for eight consecutive weeks. The primary outcomes were health-related physical fitness assessment items, including body composition (body mass index: BMI), cardiorespiratory fitness (stair-climbing test), muscular fitness (knee-bend sit-ups), and flexibility (Chair Sit and Reach Test). The post-test measurements of BMI, cardiorespiratory fitness, sit-ups, and muscular flexibility of children in the experimental group were significantly better than the pre-test measurements. The stair-climbing exercise training results for cardiorespiratory fitness, muscular fitness, and muscular flexibility in the experimental group were significantly better than those in the control group. Stair-climbing exercise improves the physical fitness of children with developmental disabilities. The results of this study suggest that children with developmental disabilities should be encouraged to engage in this convenient and easy stair-climbing exercise to improve physical performance and health status.</p> <p>Keywords: Stair-climbing; Health-related physical fitness; Children with developmental disabilities</p> <p>Copyright comment Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</p> <p>Children over age four years can coordinate going up and down stairs one step at a time. When performing stair climbing exercises, the antagonistic muscles of the hip, knee, and ankle joints must be coordinated to swing the lower limbs and transmit power from the legs to all body parts. From the viewpoint of kinesiology, kinematic and kinetic data have indicated that a greater range motion of knee flexion and movements are required for stair climbing compared to level walking (Jevsevar et al., [<reflink idref="bib15" id="ref1">15</reflink>]). The vasti lateralis thigh muscles and plantarflexor muscles of the foot are primarily responsible for vertical propulsion, while the gluteus maximus and hamstrings are the main contributors to forward propulsion. The gluteus medius governs medial control, while vasti lateralis and hamstrings perform lateral control in a coordinated manner (Novak & Brouwer, [<reflink idref="bib25" id="ref2">25</reflink>]; Wilken et al., [<reflink idref="bib30" id="ref3">30</reflink>]). These muscles collaboratively perform concentric contraction to stabilize the body and straighten the knees; when performing stair climbing exercises, the quadriceps of the thigh perform an eccentric contraction to control reduction of body speed (Theodorou et al., [<reflink idref="bib28" id="ref4">28</reflink>]). Studies have shown that stair climbing exercise slowly consumes 8.6 times more energy than sitting and is a rhythmic and aerobic physical activity closely associated with oxygen uptake (Jenkins et al., [<reflink idref="bib13" id="ref5">13</reflink>]; Teh & Aziz, [<reflink idref="bib27" id="ref6">27</reflink>]; Whittaker et al., [<reflink idref="bib29" id="ref7">29</reflink>]).</p> <p>Stair climbing exercise is a weight-bearing aerobic training activity that uses large muscle groups. It emphasizes tightening the hip, knee, and leg muscle groups, increasing muscle endurance and weight control (Eves et al., [<reflink idref="bib7" id="ref8">7</reflink>]). It can help to train eyes, hands, and feet coordination (Harper et al., [<reflink idref="bib12" id="ref9">12</reflink>]) and increases joint flexibility and bone density. Stair climbing can reduce body fat, triglycerides, high-density cholesterol (HDL), and blood glucose and improve health-related physical fitness and mechanical efficiency (Michael et al., [<reflink idref="bib23" id="ref10">23</reflink>]). Stair climbing exercise also promotes the development of skill movement in children (Bar-Haim et al., [<reflink idref="bib3" id="ref11">3</reflink>]).</p> <p>The American College of Sports Medicine defines health-related physical fitness measures as body composition, cardiorespiratory fitness, muscle fitness, and flexibility (Garber et al., [<reflink idref="bib11" id="ref12">11</reflink>]). Maintaining physical fitness, as measured by these health-related physical fitness items, is essential in children's overall health and an essential component of participation in daily life and sporting events (Chu et al., [<reflink idref="bib6" id="ref13">6</reflink>]). Physical fitness is shown to be significantly associated with motor function performance (Okely et al., [<reflink idref="bib26" id="ref14">26</reflink>]). Children with poor physical fitness will likely have unsatisfactory motor function skills and performance and are less likely to participate in sports, affecting the development of psychological, social, and competitive physical fitness (Fulton et al., [<reflink idref="bib10" id="ref15">10</reflink>]).</p> <p>For children with developmental disabilities, the physical costs associated with higher metabolic, cardiorespiratory, and mechanical exercise may result in early fatigue and decreased exercise performance, which may reduce children's willingness to exercise, and instead, they adopt an inertial sitting lifestyle (Fragala-Pinkham et al., [<reflink idref="bib9" id="ref16">9</reflink>]). When physical activity is insufficient, individuals easily become overweight, cardiorespiratory fitness deteriorates, muscle strength and flexibility decreases (Chu et al., [<reflink idref="bib6" id="ref17">6</reflink>]; Farhat et al., [<reflink idref="bib8" id="ref18">8</reflink>]). These changes may aggravate symptoms of an underlying developmental disorder, resulting in secondary diseases and affecting children's physical and mental health. However, exercise training or increased physical activity enhances children's physical fitness and overall development. The energy consumption of physical activity reduces possible disease risk factors and improves physical fitness, which promotes children's healthy growth (Bar-Haim et al., [<reflink idref="bib3" id="ref19">3</reflink>], [<reflink idref="bib4" id="ref20">4</reflink>]; Fragala-Pinkham et al., [<reflink idref="bib9" id="ref21">9</reflink>]).</p> <p>Stair climbing exercise is easy for children and adults to perform. A systematic review of the intervention design of 67 stair climbing studies in adults 18 years of age and older found that 72% of those studies supported stair climbing exercise in public sites as an effective therapeutic activity (Jennings et al., [<reflink idref="bib14" id="ref22">14</reflink>]). Most research subjects for stair climbing exercises are adults, and few reports have focused on children. Aerobics, taekwondo, walking, jogging, swimming, treadmills, and other methods are available to promote physical fitness in children or children with developmental disabilities. Notably, the stair climbing exercise does not require coaching or special equipment and is a unique venue that offers an effective form of exercise for children with developmental disabilities. Children can practice regularly at home and in public places to increase their physical activity and health. Therefore, this study aimed to investigate the effects of an eight-week, twice-weekly stair climbing exercise program on the health and physical fitness of children with developmental disabilities.</p> <hd id="AN0178837127-2">Methods</hd> <p></p> <hd id="AN0178837127-3">Participants</hd> <p>In this study adopting pretest-posttest experimental design, study participants were recruited prospectively from the pediatric rehabilitation departments of two regional teaching hospitals in Taiwan. Case inclusion criteria were: (<reflink idref="bib1" id="ref23">1</reflink>) Biological age 5–7 years old. (<reflink idref="bib2" id="ref24">2</reflink>) Disability diagnosis with physical, mental, or developmental delay. (<reflink idref="bib3" id="ref25">3</reflink>) Able to walk alone and go up and down stairs. The level of gross motor dysfunction is mild, as evidenced by mild balance problems, jump skill problems, and motor incoordination. The following were the exclusion criteria: (<reflink idref="bib1" id="ref26">1</reflink>) Is unable to walk or climb stairs independently, or has a physical disability such as cerebral palsy. (<reflink idref="bib2" id="ref27">2</reflink>) Having emotional disorders or unable to follow instructions. (<reflink idref="bib3" id="ref28">3</reflink>) Having cardiorespiratory fitness disorder (history of congenital heart disease or asthma). (<reflink idref="bib4" id="ref29">4</reflink>) Other physiological diseases that affect sports performance (epilepsy). (<reflink idref="bib5" id="ref30">5</reflink>) Family leisure activity of mountaineering (to avoid confounding factors). Finally, 30 children with developmental disabilities were enrolled. Among them, 16 (53.3%) had developmental delay, 10 (33.3%) had intellectual disability, and 4 (13.4%) had attention deficit hyperactivity disorder. Subjects were assigned to the experimental or control group by random grouping based on the same disability categories. Fifteen children with developmental disabilities or developmental delays in the experimental group, including 8 developmental delays, 5 intellectual disabilities, and 2 attention deficit hyperactivity disorders, received stair climbing exercise and physical therapy courses twice a week for eight weeks. The control group of 15 children with developmental disabilities received physical therapy twice a week, but did not receive stair climbing exercise.</p> <hd id="AN0178837127-4">Compliance with Ethical Standards</hd> <p>The purpose of the study, as well as the content of the exercise program and related testing, were communicated to the parents of all participating children in writing. The rights of those who did not want to participate in the study in the hospital were not affected in any way. If any of the children felt unwell, they were able to withdraw from the experimental research at any time. All participating children's parents signed informed consent forms. This study complied with the Declaration of Helsinki and the protocol was reviewed and approved by the Taichung Jen-Ai Hospital Institutional Review Board (IRB number 109-03) in 2020. The participants in this study were collected in agreement with the code of conduct of research with human material in Taiwan.</p> <hd id="AN0178837127-5">Measurements</hd> <p>The four items of health-related physical fitness were body composition, cardiorespiratory fitness, muscular fitness, and flexibility.</p> <hd id="AN0178837127-6">Body Composition</hd> <p>Body mass index (BMI) was calculated, and height and weight were used to estimate body composition using the following equation:</p> <olist> <item></item> </olist> <p>Graph</p> <hd id="AN0178837127-7">Cardiorespiratory Fitness</hd> <p>The three-minute stair climbing test was used to test subjects' cardiorespiratory endurance by heart rate recovery rate after three minutes of repeated steps, maintaining a detailed record of heart rate at rest and immediately after exercise. First, the beat was set and subjects were asked to repeatedly go up and down the stairs within a three-minute period. For four beats counted once, the left and right feet ascend and descend the stairs, respectively. The up and down steps are performed 30 times per minute, and the exercise time is set to three minutes (the counter records the actual number of degrees for each subject). After the test time is over, record three recovery heartbeats from the first minute to 1 min and 30 s, from the second minute to 2 min and 30 s, and from the third minute to 3 min and 30 s. If the subject feels unwell, the test can be stopped any time during the trial. The stair climbing index calculation method is as follows:</p> <p>2</p> <p>Graph</p> <hd id="AN0178837127-8">Muscular Fitness</hd> <p>The one-minute sit-up exercise was used to test children's abdominal muscle strength by the number of sit-ups completed within a given period. The subject lies on the mat with their knees bent at 90 degrees, hands crossed on the chest, palms lightly placed on the shoulders, and another person presses the subject's instep (bottom of foot) to help stabilize it. The subject is told to "use your abs to curl up and lie down with your elbows lightly touching your thighs." This action is repeated for one minute, and the number of times that can be completed within the time limit (within 60 s) is calculated.</p> <hd id="AN0178837127-9">Muscular Flexibility</hd> <p>The Sit and Reach Test was used to show muscle flexibility. Measurement steps were as follows: (<reflink idref="bib1" id="ref31">1</reflink>) The subject sits on the ground or a mat, with feet shoulder-width apart and knees straight; (<reflink idref="bib2" id="ref32">2</reflink>) The protractor is placed between the feet in a sitting posture, and the heels are against the protractor; (<reflink idref="bib3" id="ref33">3</reflink>) Two middle fingers overlap each other and start at the origin of the protractor. The upper body stretches forward as far as possible until the middle finger touches the number on the protractor and stays for 2 s, then the position where the middle finger touches the number on the protractor is recorded (Fig. 1). (<reflink idref="bib4" id="ref34">4</reflink>) A total of three tests were conducted for each subject, and the best result of the three tests were recorded.</p> <p>Graph: Fig. 1 The sit and reach test for muscular flexibility</p> <hd id="AN0178837127-10">Procedures</hd> <p>Before starting the stair climbing exercise, a pre-test of fitness is done. Two senior pediatric physical therapists, each with ten years' experience, performed the tests. Each experiment consisted of three stages: warm-up exercise, main activity, cool-down exercise, and physical therapy after the stair climbing exercise. The 5-minute warm-up exercise was mainly a gentle exercise to prevent sports injuries. The primary practice was the stair climbing exercise to improve health and fitness. Subjects were told to relax for 5 min, primarily to stretch muscles to avoid sports injuries. The training venue was the stairway connecting the floors of the hospital, which were climbed from the basement to the first floor and continuing to the ninth floor (B1-9 F). The height of a single step was 18.5 cm, and the depth of a single step was 26.5 cm, totaling 217 steps. The stair climbing exercise is a rhythmic and continuous aerobic exercise. The participants were reminded throughout the experiment that the stair climbing exercise speed should be based on the individual's consciously comfortable and fixed frequency speed. Subjects were encouraged to avoid fast and slow stair climbing exercise rhythms that may cause physical discomfort. The post-test for fitness was done one week after the 8-week stair climbing exercise.</p> <hd id="AN0178837127-11">Data Analysis</hd> <p>The Statistical Package for the Social Sciences (SPSS) version 20 (SPSS, Inc., Chicago, IL, USA) for Windows was used for all statistical analysis. The significance level was established as <emph>p</emph> = 0.05. Paired sample t-test analysis and independent sample t-test were used to measure differences between variables within and between groups.</p> <hd id="AN0178837127-12">Results</hd> <p></p> <hd id="AN0178837127-13">Study Population</hd> <p>The study sample consisted of 30 subjects, 15 in the experimental group and 15 in the control group. The mean age of children in the experimental group was 6.61 ± 0.79 years, including 3 children aged 5 years (20.0%), 5 children aged 6 years (33.3%), and 7 children aged 7 years (46.7%). The experimental group included 10 boys (66.7%) and 5 girls (33.3%). Mean height was 111.94 ± 5.53 cm, and mean weight was 19.31 ± 3.43 kg. The mean age of children in the control group was 6.24 ± 0.89 years, including 6 children aged 5 years (40.0%), 4 children aged 6 years (26.7%), and 5 children aged 7 years (33.3%). The control group included 10 boys (66.7%) and 5 girls (33.3%). Mean height was 110.93 ± 8.02 cm, and mean weight was 19.27 ± 2.90 kg.</p> <hd id="AN0178837127-14">Pre-Test Results of Experimental Subjects vs. Controls</hd> <p>Physical fitness pre-tests for the two groups were compared with the independent samples t-test prior to the 8-week stair ascending exercise intervention to determine if there were any baseline differences in physical fitness between the two groups. The results showed that the body composition (t = 0.02, p = 0.99), cardiorespiratory fitness (t = 1.69, p = 0.1), muscular fitness (t=-1.15, p = 0.26), and muscular flexibility (t = 0.47, p = 0.65) difference test results, there was no significant difference (p > 0.05) (Table 2), which means that the physical fitness levels of the two groups were not significantly different before the intervention of stair ascending exercise. According to standards published by the National Health Administration of Taiwan's Ministry of Health and Welfare (2013), underweight was defined as a BMI of less than 14 and overweight is defined as a BMI greater than 20. BMI measurements revealed that neither group's participants were overweight nor underweight (Table 2).</p> <p>Table 1 Demographic data of children in the experimental and control groups</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left" /><th align="left" colspan="2"><p>Experimental group</p></th><th align="left" colspan="2"><p>Control group</p></th></tr><tr><th align="left" /><th align="left" /><th align="left"><p>number</p></th><th align="left"><p>%</p></th><th align="left"><p>number</p></th><th align="left"><p>%</p></th></tr></thead><tbody><tr><td align="left"><p>Age</p></td><td align="left"><p>5</p></td><td align="left"><p>6</p></td><td align="left"><p>40.0</p></td><td align="left"><p>3</p></td><td align="left"><p>20.0</p></td></tr><tr><td align="left" /><td align="left"><p>6</p></td><td align="left"><p>4</p></td><td align="left"><p>26.7</p></td><td align="left"><p>5</p></td><td align="left"><p>33.3</p></td></tr><tr><td align="left" /><td align="left"><p>7</p></td><td align="left"><p>5</p></td><td align="left"><p>33.3</p></td><td align="left"><p>7</p></td><td align="left"><p>46.7</p></td></tr><tr><td align="left"><p>Sex</p></td><td align="left"><p>male</p></td><td align="left"><p>10</p></td><td align="left"><p>66.7</p></td><td align="left"><p>5</p></td><td align="left"><p>33.3</p></td></tr><tr><td align="left" /><td align="left"><p>female</p></td><td align="left"><p>5</p></td><td align="left"><p>33.3</p></td><td align="left"><p>3</p></td><td align="left"><p>20.0</p></td></tr></tbody></table> </ephtml> </p> <p>Table 2 Comparison of pre-test physical fitness measures between experimental and control groups</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left" colspan="2"><p>Experimental group</p></th><th align="left" colspan="2"><p>Control group</p></th><th align="left" /><th align="left" /></tr><tr><th align="left"><p>Physical fitness</p></th><th align="left"><p>M</p></th><th align="left"><p>SD</p></th><th align="left"><p>M</p></th><th align="left"><p>SD</p></th><th align="left"><p><italic>t</italic></p></th><th align="left"><p><italic>p</italic></p></th></tr></thead><tbody><tr><td align="left"><p>Body composition</p></td><td align="left"><p>15.25</p></td><td align="left"><p>1.86</p></td><td align="left"><p>15.23</p></td><td align="left"><p>1.89</p></td><td align="left"><p>0.02</p></td><td align="left"><p>0.99</p></td></tr><tr><td align="left"><p>Cardiorespiratory</p></td><td align="left"><p>32.40</p></td><td align="left"><p>1.23</p></td><td align="left"><p>31.58</p></td><td align="left"><p>1.41</p></td><td align="left"><p>1.69</p></td><td align="left"><p>0.10</p></td></tr><tr><td align="left"><p>Muscular fitness</p></td><td align="left"><p>10.67</p></td><td align="left"><p>2.16</p></td><td align="left"><p>11.53</p></td><td align="left"><p>1.96</p></td><td align="left"><p>-1.15</p></td><td align="left"><p>0.26</p></td></tr><tr><td align="left"><p>Flexibility</p></td><td align="left"><p>21.13</p></td><td align="left"><p>2.26</p></td><td align="left"><p>20.80</p></td><td align="left"><p>1.61</p></td><td align="left"><p>0.47</p></td><td align="left"><p>0.65</p></td></tr></tbody></table> </ephtml> </p> <p>Test results for cardiorespiratory fitness revealed mean = 32.4 ± 1.23 for the experimental group and mean = 31.58 ± 1.41 for the control group. According to the national physical fitness norm report published by the Sports Committee of the Taiwan Executive Yuan as a reference test, the average value of the cardiopulmonary index for stair climbing exercise was 54.56–58.44; performance for stair climbing exercise was less than 50.00, showing poor cardiopulmonary performance for both experimental and control groups.</p> <p>Muscular fitness test results showed the experimental group mean was 10.67 ± 2.16, and the control group mean was 11.53 ± 1.96. According to the national physical fitness norm report released by the Sports Committee of the Taiwan Executive Yuan, the average performance is about 14 to 21 times in one minute, while poor performance is less than seven times per minute, indicating that both the experimental group and control group had poor performance.</p> <p>For muscular flexibility, the means were 21.13 ± 2.26 for the experimental group and 20.80 ± 1.61 for the control group. According to the national physical fitness norm report published by the Sports Committee of the Taiwan Executive Yuan as the testing standard: the normal muscular flexibility is about 26–32 cm, while poor muscular flexibility is less than 21–24 cm, showing that both groups of children with developmental disabilities bordered on muscular inflexibility.</p> <hd id="AN0178837127-15">Comparison of Pre-and Post-Test Differences in Physical Fitness by Group</hd> <p>Children in the experimental group received stair climbing exercise training and physical therapy twice a week for eight weeks, body composition (t = 4.03, p = 0.001), cardiorespiratory fitness (t = 7.05, p = 0.000), muscular fitness (t = 4.66, p = 0.000), and muscular flexibility (t = 4.68, p = 0.000) all showed significant differences between pre-test and post-test (Table 3).</p> <p>Table 3 Pre- tests and post-tests of physical fitness in the experimental group (n=15)</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left" colspan="2"><p>Pretest</p></th><th align="left" colspan="2"><p>Posttest</p></th><th align="left" /><th align="left" /></tr><tr><th align="left"><p>Physical fitness</p></th><th align="left"><p>Mean</p></th><th align="left"><p>SD</p></th><th align="left"><p>Mean</p></th><th align="left"><p>SD</p></th><th align="left"><p><italic>t</italic></p></th><th align="left"><p>p</p></th></tr></thead><tbody><tr><td align="left"><p>Body composition</p></td><td align="left"><p>15.25</p></td><td align="left"><p>1.86</p></td><td align="left"><p>15.59</p></td><td align="left"><p>1.84</p></td><td align="left"><p>4.03<sup>***</sup></p></td><td align="left"><p>0.001</p></td></tr><tr><td align="left"><p>Cardiorespiratory</p></td><td align="left"><p>32.40</p></td><td align="left"><p>1.23</p></td><td align="left"><p>35.70</p></td><td align="left"><p>2.19</p></td><td align="left"><p>7.05<sup>***</sup></p></td><td align="left"><p>0.000</p></td></tr><tr><td align="left"><p>Muscular fitness</p></td><td align="left"><p>10.67</p></td><td align="left"><p>2.16</p></td><td align="left"><p>12.53</p></td><td align="left"><p>2.62</p></td><td align="left"><p>4.66<sup>***</sup></p></td><td align="left"><p>0.000</p></td></tr><tr><td align="left"><p>Flexibility</p></td><td align="left"><p>21.13</p></td><td align="left"><p>2.26</p></td><td align="left"><p>23.27</p></td><td align="left"><p>2.46</p></td><td align="left"><p>4.68<sup>***</sup></p></td><td align="left"><p>0.000</p></td></tr></tbody></table> </ephtml> </p> <p>***:P<0.001</p> <p>After eight weeks of physical therapy, body composition in children in the control group improved significantly (t = 3.36, p = 0.005). Cardiorespiratory fitness (t = 1.325, p = 0.208), muscular fitness (t = 1.00, p = 0.334), and muscular flexibility (t = 1.15, p = 0.271) were not significantly different between pre-test and post-test (Table 4).</p> <p>Table 4 Analysis of pre- and post-test differences in physical fitness in the control group (n=15)</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left" colspan="2"><p>Pre-test</p></th><th align="left" colspan="2"><p>Post-test</p></th><th align="left" /><th align="left" /></tr><tr><th align="left"><p>Physical fitness</p></th><th align="left"><p>Mean</p></th><th align="left"><p>SD</p></th><th align="left"><p>Mean</p></th><th align="left"><p>SD</p></th><th align="left"><p><italic>t</italic></p></th><th align="left"><p>p</p></th></tr></thead><tbody><tr><td align="left"><p>Body composition</p></td><td align="left"><p>15.23</p></td><td align="left"><p>1.89</p></td><td align="left"><p>15.64</p></td><td align="left"><p>1.81</p></td><td align="left"><p>3.36<sup>**</sup></p></td><td align="left"><p>0.005</p></td></tr><tr><td align="left"><p>Cardiorespiratory</p></td><td align="left"><p>31.58</p></td><td align="left"><p>1.41</p></td><td align="left"><p>31.76</p></td><td align="left"><p>1.33</p></td><td align="left"><p>1.32</p></td><td align="left"><p>0.208</p></td></tr><tr><td align="left"><p>Muscular fitness</p></td><td align="left"><p>11.53</p></td><td align="left"><p>1.96</p></td><td align="left"><p>11.67</p></td><td align="left"><p>2.09</p></td><td align="left"><p>1.00</p></td><td align="left"><p>0.334</p></td></tr><tr><td align="left"><p>Flexibility</p></td><td align="left"><p>20.80</p></td><td align="left"><p>1.61</p></td><td align="left"><p>21.00</p></td><td align="left"><p>1.69</p></td><td align="left"><p>1.15</p></td><td align="left"><p>0.271</p></td></tr></tbody></table> </ephtml> </p> <hd id="AN0178837127-16">Differences in Performance Between the Experimental and Control Groups</hd> <p>After eight weeks of physical therapy alone, the control group with no stair climbing exercise showed significant improvement in body composition. As a result, it was necessary to test whether there were significant differences in the progress of the two groups to determine whether the experimental group's progress was due to natural growth and physical therapy or to the stair climbing exercise. The progress score was calculated by subtracting post-test scores from pre-test scores. If no significant difference in progress was found between the two groups, it means that the experimental group's progress was due to natural growth or the effects of physical therapy. If there are significant differences between the two groups, this reflects the effects of the stair climbing exercise. Results showed that no significant differences were found between the improvement of body composition in the experimental group and improvement in the control group (t=-0.40, p = 0.689). The cardiorespiratory fitness of the experimental group was significantly different from that of the control group (t = 6.41, p < 0.001). The experimental group's muscular fitness improvement was significantly different from that of the control group (t = 4.10, p = 0.001). The progress of muscular flexibility in the experimental group was significantly different from that in the control group (t = 3.96, p = 0.001) (Table 5). These results clearly indicate that the experimental group improved significantly compared to the control group after the stair climbing exercise.</p> <p>Table 5 Pre- and post- test differences showing progress by group</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left" colspan="2"><p>Experimental group</p></th><th align="left" colspan="2"><p>Control group</p></th><th align="left" /><th align="left" /></tr><tr><th align="left"><p>The progress</p></th><th align="left"><p>Mean</p></th><th align="left"><p>SD</p></th><th align="left"><p>Mean</p></th><th align="left"><p>SD</p></th><th align="left"><p><italic>t</italic></p></th><th align="left"><p>p</p></th></tr></thead><tbody><tr><td align="left"><p>body composition</p></td><td align="left"><p>0.34</p></td><td align="left"><p>0.09</p></td><td align="left"><p>0.41</p></td><td align="left"><p>0.12</p></td><td align="left"><p>-0.40</p></td><td align="left"><p>0.689</p></td></tr><tr><td align="left"><p>cardiorespiratory</p></td><td align="left"><p>3.30</p></td><td align="left"><p>0.47</p></td><td align="left"><p>0.18</p></td><td align="left"><p>0.13</p></td><td align="left"><p>6.41<sup>***</sup></p></td><td align="left"><p>0.000</p></td></tr><tr><td align="left"><p>muscular fitness</p></td><td align="left"><p>1.86</p></td><td align="left"><p>0.40</p></td><td align="left"><p>0.14</p></td><td align="left"><p>0.13</p></td><td align="left"><p>4.10<sup>***</sup></p></td><td align="left"><p>0.001</p></td></tr><tr><td align="left"><p>flexibility</p></td><td align="left"><p>2.14</p></td><td align="left"><p>0.46</p></td><td align="left"><p>0.20</p></td><td align="left"><p>0.18</p></td><td align="left"><p>3.96<sup>***</sup></p></td><td align="left"><p>0.001</p></td></tr></tbody></table> </ephtml> </p> <p> <sups>***</sups>: <emph>p</emph><0.001</p> <hd id="AN0178837127-17">Discussion</hd> <p></p> <hd id="AN0178837127-18">Body Composition</hd> <p>The WHO (2000) states that BMI is the best indicator of children's growth and development. At a average body weight and at a speed of 3 km/h, climbing stairs for one hour consumes about 520 kcal (23% more than jogging, 4 times more than walking) (Koszuta, [<reflink idref="bib17" id="ref35">17</reflink>]). Climbing stairs is a commonplace physical activity that burns more calories per minute than jogging. Climbing 10 flights of stairs is approximately equivalent to running 1000 m. In our study, the stair-climbing exercise was from the basement to the first floor and then to the ninth floor (B1-9 F), which was equivalent to climbing 10 floors. However, the pre-test BMI values of the two groups were in the normal range, with no significant differences between the experimental and control groups, which may suggest that improvement in the experimental group was not significantly greater than that of the control group. The lack of a significant difference could be explained by the fact that the average body weight of all subjects in this study, 19.29 ± 3.12 kg, is equivalent to the Taiwan norm database standard (6-year-old body weight (22.41 ± 5.77). Although body composition changes with age and maturity, BMI typically decreases in early childhood, peaks between the ages of 5 and 7 years, and then continues to increase with age (Krebs et al., [<reflink idref="bib18" id="ref36">18</reflink>]). Eves' research findings differed from those of our study. Body composition as measured by BMI increased in both the experimental and control groups in the current study, indicating that the physical growth rate of preschool children is increasing steadily. Therefore, this study showed that climbing stairs cannot effectively increase body composition.</p> <hd id="AN0178837127-19">Cardiorespiratory Fitness</hd> <p>The experimental group showed significant improvement in cardiorespiratory fitness, which may be explained as follows: (<reflink idref="bib1" id="ref37">1</reflink>) Stair climbing strengthens cardiac contraction and improves cardiorespiratory capacity (Meyer et al., [<reflink idref="bib22" id="ref38">22</reflink>]). (<reflink idref="bib2" id="ref39">2</reflink>) Stair climbing also reduces energy consumption and increases mechanical efficiency. (<reflink idref="bib3" id="ref40">3</reflink>) Cardiorespiratory fitness improves through the continuous use of large muscle groups in the body over a long duration and the rhythmic and aerobic physical activity of stair climbing (Harper et al., [<reflink idref="bib12" id="ref41">12</reflink>]; Lee, [<reflink idref="bib19" id="ref42">19</reflink>]).</p> <p>In Chen et al.'s stair-climbing study, men's heartbeats per minute increased to 135 when climbing the stairs to the 18th floor, the average relative heart rate increased to 60%, and women's heartbeats per minute increased to 150. Its relative heart rate increased to 70% on average (Chen et al., [<reflink idref="bib5" id="ref43">5</reflink>]). In addition, subjects hold on to the handrail to ensure continued stair-climbing activity as they walked to higher floors. However, the subjects in this study were asked to use their own comfortable speed to climb the stairs, and the subjects also used their own way to climb the stairs, such as holding on to the handrail or not holding on to the handrail.</p> <p>In a previous study of cerebral palsy patients aged 5 to 15 years climbing ladders, results showed that dHR and mechanical efficiency benefits from stair climbing exercise predicts motor performance (Bar-Haim et al., [<reflink idref="bib3" id="ref44">3</reflink>]), and can be used to assess children's development or intervention effects. However, few studies of cardiorespiratory fitness have been conducted in children using stair climbing exercise compared to those conducted in adults. A study of 24 young adults who exercised less than 1 h per week in college showed that, after six weeks of brief, intermittent stair climbing exercise, the experimental group increased cardiorespiratory performance by 5%, significantly higher than the control group, and benefitting cardiorespiratory fitness (Jenkins et al., [<reflink idref="bib13" id="ref45">13</reflink>]). Fulton studied 31 sedentary women who performed a 6-week program of short, intermittent stair climbing exercise for 1–3 min. Despite the short exercise time, experimental results still showed significant improvement in the subjects' cardiorespiratory fitness (Fulton et al., [<reflink idref="bib10" id="ref46">10</reflink>]). These findings are similar to those in the present study, in which the experimental group achieved significant improvement in cardiorespiratory fitness. Walking uphill has more exercise effects than walking on a flat surface in terms of implication of stair climbing exercise. Stair climbing is less tiring than brisk walking because the stairs have a slope that belongs to the characteristics of vertical upward movement, which will have a more noticeable effect on cardiorespiratory endurance and energy consumption.</p> <hd id="AN0178837127-20">Muscular Fitness</hd> <p>Stair climbing exercise is a weight-bearing aerobic exercise performed in an upward vertical direction. Movement in the stair climbing exercise requires more balance than is needed on a flat surface (Harper et al., [<reflink idref="bib12" id="ref47">12</reflink>]), generating greater ground reaction forces and knee movements (Nadeau et al., [<reflink idref="bib24" id="ref48">24</reflink>]), thus strengthening muscles in the lower extremity and torso (Lee et al., [<reflink idref="bib20" id="ref49">20</reflink>]; Lee, [<reflink idref="bib19" id="ref50">19</reflink>]; Yoon et al., [<reflink idref="bib33" id="ref51">33</reflink>]). Stair climbing exercise also increases abdominal strength, including the internal oblique abdominals (Lee et al., [<reflink idref="bib20" id="ref52">20</reflink>]), and reverse abdominals (Lee, [<reflink idref="bib19" id="ref53">19</reflink>]). In the present study, when performing stair climbing, physical actions shift vertically and horizontally, strengthening the trunk and lower extremities, thereby increasing muscle strength in children with developmental disabilities, which improves cardiorespiratory fitness (Teh & Aziz, [<reflink idref="bib27" id="ref54">27</reflink>]). A previous study also found significant correlations between physical activity, motor development, and multiple physical fitness benefits (Wouters et al., [<reflink idref="bib31" id="ref55">31</reflink>]), improving specific health parameters and enhancing overall health. The results of the study indicated that climbing stairs can improve the muscular fitness of the experimental group. Climbing stairs can strengthen the body's muscles and increase bone density. Stepping is a weight-bearing and aerobic training activity that uses large muscle groups to strengthen the weight-bearing muscle endurance effect of the leg muscles and hip and knee joints.</p> <hd id="AN0178837127-21">Muscular Flexibility</hd> <p>Flexibility refers to range of motion of the joints, influenced by muscle contraction and extensibility of non-contracted tissues (joint capsules, ligaments, and tendons). Flexibility is measured to evaluate toughness or extension of the muscles, tendons and ligaments, and other tissues in the legs and lower back. Decreased flexibility may lead to poor body posture, resulting in restricted joint movement or pain. School children with developmental disabilities may be limited by their disease and have low tissue extensibility (ability to be stretched), requiring daily stretching exercises to improve range of motion in their joints. Individuals with developmental disabilities benefit from physical and mental activity, with resistance training providing the most significant physical benefits (Kapsal et al., [<reflink idref="bib16" id="ref56">16</reflink>]). Akkurt et al. ([<reflink idref="bib1" id="ref57">1</reflink>]) treated 5-year-olds with Duchenne muscular dystrophy with physical therapy, which improved lumbar lordosis and increased hamstring flexibility (Akkurt et al., [<reflink idref="bib1" id="ref58">1</reflink>]). Results of that study differed from those of the present study, in which increased muscular flexibility depended on combining physical therapy with physical fitness training using stair climbing. Stair climbing exercise is a vertically-acting, weight-bearing resistance activity. While one foot supports the knee and maintains a straight posture, the other foot steps up one step, which is equal to children's voluntary extension of muscle length. Stair climbing exercise has a similar effect—increasing extension across the trunk (thoracic spine, lumbar spine, gluteal muscles), lower limbs (gastrocnemius, hamstring) and back muscles. Wu et al. provided 40 min of physical fitness activities four times/week for six months for 146 individuals aged 19–67 years institutionalized with intellectual disabilities. Significant improvements were found in body composition, sit and reach, and 30-second and 60-second sit-ups in these individuals post-intervention (Wu et al., [<reflink idref="bib32" id="ref59">32</reflink>]). In Taiwan, the most common physical activities of adolescents with developmental disabilities are walking, sports, and jogging (Lin et al., [<reflink idref="bib21" id="ref60">21</reflink>]). The current study's findings support the notion that stair-climbing exercise can effectively increase muscular flexibility. Muscular flexibility allows the trunk's central axis or limb extensibility to perform flexion, extension, and rotation actions, and the muscles and joints are not pulled and injured as a result of excessive stiffness. As a result, having adequate muscular flexibility can help us be more efficient when exercising and avoid sports injuries (ACSM, [<reflink idref="bib2" id="ref61">2</reflink>]). This exercise is a practical, easy-to-implement, and easy-to-do exercise method. Therefore, performing the stair-climbing exercise is recommended for children with developmental disabilities to promote their physical fitness and overall health.</p> <hd id="AN0178837127-22">Strengths and Limitations</hd> <p>Strengths of the present study are in the individualized design and support for participants, who were allowed to complete the stair climbing exercise activity under each patient's physical tolerance limit. No mandatory completion times or speeds were applied. The researchers used encouragement and reassurance to help the participants perform the process smoothly. Under normal conditions, shorter times to complete each stair climbing activity require faster speed and higher intensity. Therefore, we suggest that future research on correlations between stair climbing exercise speed and results of health-related physical fitness measures can expand the intervention. Motor function was not included in the present study and future research should explore the relationship between improving those specific health-related physical fitness measures through stair climbing exercise training and add measures of the functional activities of daily life. Although the experimental location of this study was in a hospital, the stair climbing exercise can be conveniently performed at home. Therefore, future studies can be performed in subjects' homes and still measure effectiveness. The scope of cases included in this study was limited to two regional teaching hospitals, and the number of cases was small, limiting generalizability of results to other populations or locations. Future research could look into different age groups, different disabilities, and different climbing methods (such as one foot and one step, two feet and one step). The study of correlations, such as stair climbing exercise speed and fitness, may benefit from expanding the sample.</p> <hd id="AN0178837127-23">Conclusions</hd> <p>Stair climbing exercise training is beneficial for children with developmental disabilities, demonstrating improvements in body composition, cardiorespiratory fitness, muscular fitness and flexibility. Stair climbing exercise combined with physical therapy is more effective than physical therapy alone. These results suggest that children with developmental disabilities should be encouraged to engage in this convenient and easy stair-climbing exercise to improve physical performance and health status. We did not limit the time spent on stair-climbing exercise, therefore it is suggested that ffuture research can measure and analyze the relationship between stair-climbing time and physical fitness. Future research could include two independent variables, stair inclination and subject height, to investigate their impact on kinematic and kinetic patterns of knee or health-related physical fitness during stair climbing.</p> <hd id="AN0178837127-24">Funding</hd> <p>The study was not supported by any grant.</p> <hd id="AN0178837127-25">Compliance with Ethical Standards</hd> <p></p> <hd id="AN0178837127-26">Conflict of Interest</hd> <p>The authors declare that they have no conflicts of interest.</p> <hd id="AN0178837127-27">Ethical Approval</hd> <p>This article does not contain any studies involving animals performed by any of the authors. 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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Effects of Stair-Climbing Exercise on Health-Related Physical Fitness Measures in Children with Developmental Disabilities
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Lin+Wen-Li%22">Lin Wen-Li</searchLink><br /><searchLink fieldCode="AR" term="%22Chien-Lin+Lin%22">Chien-Lin Lin</searchLink><br /><searchLink fieldCode="AR" term="%22Chin-Kai+Lin%22">Chin-Kai Lin</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-4049-2842">0000-0002-4049-2842</externalLink>)
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  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Developmental+and+Physical+Disabilities%22"><i>Journal of Developmental and Physical Disabilities</i></searchLink>. 2024 36(4):681-695.
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  Label: Availability
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  Data: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 15
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2024
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Exercise%22">Exercise</searchLink><br /><searchLink fieldCode="DE" term="%22Physical+Fitness%22">Physical Fitness</searchLink><br /><searchLink fieldCode="DE" term="%22Measurement%22">Measurement</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Developmental+Disabilities%22">Developmental Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Pediatrics%22">Pediatrics</searchLink><br /><searchLink fieldCode="DE" term="%22Hospitals%22">Hospitals</searchLink><br /><searchLink fieldCode="DE" term="%22Rehabilitation%22">Rehabilitation</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Health%22">Health</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Taiwan%22">Taiwan</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1007/s10882-023-09927-3
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1056-263X<br />1573-3580
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Children with developmental disabilities lack sufficient physical activity in their daily lives. The purpose of this study was to see if children with developmental disabilities who participated in stair-climbing exercises had better physical performance and health status than children with developmental disabilities who did not. This study adopted a pre-and-post-test experimental design, enrolling 30 subjects (experimental group, 15; control group, 15) with developmental disabilities aged 5-7 years from pediatric rehabilitation treatment departments of two regional teaching hospitals in Taiwan. The experimental group received stair-climbing exercises and physical therapy twice a week for eight consecutive weeks. The primary outcomes were health-related physical fitness assessment items, including body composition (body mass index: BMI), cardiorespiratory fitness (stair-climbing test), muscular fitness (knee-bend sit-ups), and flexibility (Chair Sit and Reach Test). The post-test measurements of BMI, cardiorespiratory fitness, sit-ups, and muscular flexibility of children in the experimental group were significantly better than the pre-test measurements. The stair-climbing exercise training results for cardiorespiratory fitness, muscular fitness, and muscular flexibility in the experimental group were significantly better than those in the control group. Stair-climbing exercise improves the physical fitness of children with developmental disabilities. The results of this study suggest that children with developmental disabilities should be encouraged to engage in this convenient and easy stair-climbing exercise to improve physical performance and health status.
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  Data: As Provided
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  Label: Entry Date
  Group: Date
  Data: 2024
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  Label: Accession Number
  Group: ID
  Data: EJ1434154
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1434154
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    Identifiers:
      – Type: doi
        Value: 10.1007/s10882-023-09927-3
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 15
        StartPage: 681
    Subjects:
      – SubjectFull: Exercise
        Type: general
      – SubjectFull: Physical Fitness
        Type: general
      – SubjectFull: Measurement
        Type: general
      – SubjectFull: Children
        Type: general
      – SubjectFull: Developmental Disabilities
        Type: general
      – SubjectFull: Pediatrics
        Type: general
      – SubjectFull: Hospitals
        Type: general
      – SubjectFull: Rehabilitation
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      – SubjectFull: Foreign Countries
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      – SubjectFull: Health
        Type: general
      – SubjectFull: Taiwan
        Type: general
    Titles:
      – TitleFull: Effects of Stair-Climbing Exercise on Health-Related Physical Fitness Measures in Children with Developmental Disabilities
        Type: main
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            NameFull: Lin Wen-Li
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            NameFull: Chien-Lin Lin
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            NameFull: Chin-Kai Lin
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            – D: 01
              M: 08
              Type: published
              Y: 2024
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            – Type: issn-print
              Value: 1056-263X
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              Value: 1573-3580
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              Value: 36
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              Value: 4
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            – TitleFull: Journal of Developmental and Physical Disabilities
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